Claims Adjuster

ONESOURCE CLAIMS MANAGEMENT SOLUTIONS, LLC (A VENBROOK GROUP, LLC COMPANY) SEEKS A FULL-TIME TPA ADJUSTER. THE SUCCESSFUL CANDIDATE MUST HAVE FIVE YEARS OR MORE EXPERIENCE ADJUSTING COMMERCIAL LIABILITY, EXCESS LIABILITY, AND D&O
LIABILITY CLAIMS AS A TPA ADJUSTER.

Overview

The TPA Adjuster will investigate, evaluate, reserve, negotiate, and resolve assigned claims following company guidelines and client Service Level Agreements. The adjuster will provide timely, accurate, fair, and professional service to all clients, insured parties, and third parties while maintaining a high production level.

Key Responsibilities:

• Conducts thorough investigations consistent with claim handling guidelines and best practices
• Bills time and expense in the company claims system for all work performed where required
• Reaches the correct claim outcome based on a thorough coverage analysis, review of field reports, verifiable damage, and other information
• Interviews, telephones, or corresponds with insureds, claimants, retail agents, brokers, MGAs, vendors, carriers, witnesses, public adjusters, attorneys, etc., to gather vital information to support the claims
• Sets, reviews, and updates proper reserves
• Prepares releases, conducts ISO checks, and Medicare searches
• Requests claim payments and maintains file reserves
• Manages a full caseload
• Takes recorded statements as needed
• Reviews and evaluates assigned claims for coverage and conducts other claims-related tasks within the required statutory or regulatory time frame
• Interprets policy language and evaluates coverage issues across different policies and endorsements
• Uses and maintains a claims diary
• Responds promptly and effectively to emails, phone calls, messages and incoming correspondence from clients, insureds, retail agents, brokers, and management.
• Prepares technical claim documents and correspondence to insurers and other recipients
• Prepares reports detailing investigative findings
• Assigns and works closely with coverage counsel and defense counsel when needed
• Contributes to department efforts with an emphasis on team collaboration
• Other Duties as assigned

Qualifications:

• Prior experience billing time and expense for work performed is required
• Carrier experience desk adjusting commercial liability claims, excess liability claims, and D&O claims is strongly preferred
• Must be proficient with the Medicare process
• Experience with Xactimate, Eagleview, Hover, and similar applications preferred
• Must hold or can quickly obtain the required adjusting licenses in all states that require them
• Prior experience analyzing coverage and preparing coverage declination letters, ROR letters, technical reports, and other documents is required.
• Must have prior litigation experience.
• Strong writing and communication skills are a must
• Must have excellent decision-making skills and the ability to work independently
• Good organization and time management skills
• Analytical and proactive claim-handling skills
• Excellent customer service skills
• The ability to manage a full caseload in a fast-paced environment is a must
• Proficient computer & typing skills - working knowledge of MS Office: Word, Excel, and Outlook
• Familiar with a variety of field concepts, practices, and procedures
• The ability to speak Spanish is a plus

Job Type: Full-time

Experience:

• Five or more years of adjusting commercial general liability and excess claims for a TPA
• Experience adjusting D&O liability claims preferred

Education:

• College degree required
• One or more insurance designations preferred
• Juris Doctorate a plus

License/Certification:

• Adjusting licenses in all states that require them (Required)

Work Location: Remote