Casualty Claims Adjuster II

Essential Functions:

• Promptly investigates and evaluates moderately complex auto and casualty claims

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees

• Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation

• Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system

• Request and analyze investigative and other relevant reports, claim forms and documents when appropriate

• Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system

• Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology

• Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence

• Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines

• Handles litigated files of low complexity

• Recommends and obtains authority from appropriate people leader in the assignment of defense counsel

• Assigns and manages vendors for accuracy and appropriateness with supervisory approval as appropriate

• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness

• Notifies the people leader of claims that may need escalation or reassignment.

• Drafts reservation of rights and coverage denial letters with supervisor approval

• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims

• Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner

• Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains appropriate higher authority as required

• Identifies and protects all liens as appropriate

• Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines

• Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims

• Attends and assists with suits, mediations, and arbitrations

• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed

• Issues timely payments

• Reviews and audits estimates written by independent adjusters, body shops, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach

• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal as appropriate

• Prepares risk reports for Underwriting and Risk Improvement

• Reviews coverage intent and policy activity with Underwriting

• Reviews account inspection information with Risk Improvement

• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage

• Assists claims team members as appropriate in handling of claims

• Participates in projects as assigned

• Trains, and serves as a technical resource for team members

Education & Experience:

• Bachelor’s degree or equivalent relevant experience

• Three years of casualty claims adjusting experience or related experience

• Relevant insurance designations preferred

Knowledge, Skills & Abilities:

• Strong knowledge of the theory and practice of the claim function

• Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws

• Strong knowledge of computers and claims systems

• Ability to obtain all applicable state licenses

• Ability to adhere to high standards of professional conduct and code of ethics

• Good organizational and empathetic interpersonal skills

• Strong written and verbal communication skills

• Strong investigative and problem-solving abilities

• Excellent customer service skills

• Ability to maintain confidentiality

• Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling

**Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $62,344.10 - $80,035.80. The hiring range for other locations may vary.**