• Reviews the claim notices, lawsuits, contracts and policies to verify coverage, deductibles, claim payee/mortgagees and compensability
• Initiates prompt contact with customers to obtain information on the claim and explain the claim process
• Takes statements from insureds/claimants/witnesses and documents summaries within the claims system
• Documents handling activity including Medicare (MSP) modules in the claims system
• Sets timely, adequate reserves in compliance with the company reserving philosophy and
• methodology
• Obtains authority in the selection of appropriate defense counsel for assignment based on the type of suit and complexity of the matter for litigated claims
• Handles medium to lower complexity lawsuits
• Resolves questions of coverage, liability and the value of claims
• Drafts reservation of rights and denial letters when appropriate
• Assigns independent adjusters when necessary with supervisory approval
• Secures all necessary official reports, claim forms and documents
• Reviews bills, invoices and receipts for accuracy
• Reviews legal invoices and litigation related expenses for accuracy and appropriateness
• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims
• Identifies, investigates, and proactively pursues opportunities for recovery
• Prepares bodily injury and/or property damage evaluations, analyzes negotiation ranges and target settlement numbers prior to negotiation
• Communicates with insureds/claimants/attorneys to negotiate the settlement of claims
• Assists in suits, mediations, arbitrations and attending depositions
• Participates in Claims roundtables
• Issues settlement documents and verifies that they are properly executed
• Issues timely payments within check authority limit
• Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines
• Submits referrals to the Estimatics Review, Special Investigation, Property Review, Subrogation, Corporate Office Coverage Counsel, and Medical Review Units, when necessary
• Prepares risk reports for Underwriting
• Reviews coverage intent and policy activity with Underwriting
• Reviews account inspection information with Risk Improvement
• Assists own branch claims team members as needed. Acts as a mentor/coach for less experienced branch claims team members. Assists other branches in handling of claims (due to storms or temporary staffing gaps) through Resource Sharing Program. Participates in branch and department projects.

Education & Experience:

• Bachelor’s degree or equivalent relevant experience
• Five years of claims adjusting experience
• Attainment of all applicable state licenses within six months of hire
• Relevant insurance designations preferred

Knowledge, Skills & Abilities:

• Proven, excellent knowledge of the theory and practice of the claim function
• Analytical ability and sound judgment with respect to liability and coverage
• Strong knowledge of insurance contracts, medical terminology and legal aspects of court procedures
• High standards of professional conduct
• Strong knowledge of computers and claims systems
• Strong organizational and written and verbal communication skills
• Excellent investigative and problem-solving abilities
• Travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling