10 Nov
Senior Commercial Claims Examiner/Adjuster
Vacancy expired!
- Makes timely initial contact and appropriate follow up contact with all relevant parties to provide explanation of claim process, set expectations, gather facts and provide information on developments.
- Performs and documents initial coverage analysis and recognizes potential coverage issues
- Conducts, directs and/or oversees the development of facts necessary to address coverage, liability and damage aspects of the claim
- Evaluates facts to properly analyze applicable coverage issues
- Drafts coverage letters including declinations, reservation of rights, excess and partial denials
- Applies relevant jurisdictional laws and uses independent judgement to reach liability determinations based upon the facts
- Gathers appropriate supporting damage documentation and evaluates amounts owed based upon analysis of coverage, liability and relevant jurisdictional laws
- Effectively communicates claim decisions verbally and in writing to policyholders, claimants, attorneys and agents
- Properly updates claim file with key activities and documents
- Maintains effective diary system to bring claims to timely resolution
- Communicates effectively with internal business partners including Customer Service and Underwriting
- Develops constructive relationships and works effectively with outside vendors such as independent adjusters and defense counsel
- Establish appropriate reserves based upon competent analysis of coverage, liability and damages and adjust reserves as necessary in a timely manner upon receipt of additional relevant information.
- Apply common sense and cost-benefit analysis to claim decisions
- Complete necessary claim reporting to management including high exposure alert notifications
- Evaluates and resolves liability claims within scope of authority
- Conducts Medicaid/Medicare reporting in accordance with federal law
- Reviews invoices for accuracy and completes timely expense and indemnity disbursements assuring compliance with tax reporting requirements
- Oversees handling of cases in litigation and provides appropriate guidance to defense counsel
- Attends and actively participates in mediations and other forms of alternate dispute resolution where required by the court or where appropriate to move the claim to a timely and proper resolution
- Recognizes potential third party tortfeasors and develops facts to support the likeliness of successful recovery
- Prepares appropriate claim updates for management and excess carriers
- Participates in claims reviews presents issues and recommendations in a precise and understandable manner
- Exceptional customer service skills
- Emotional intelligence and ability to manage conflict
- Advanced analytical, problem-solving and decision making skills
- Ability to communicate effectively verbally and in writing with varying audiences
- Excellent negotiation skills and track record of proven results
- Team-player who is comfortable working in a dynamic, entrepreneurial environment
- Willingness to simultaneously work on multiple projects and fulfill multiple roles
- Proven leadership and mentoring capabilities
- Ability to interpret a variety of policy forms and endorsements
- History of litigation claims management and working effectively with defense counsel
- Familiarity with reading and interpreting contracts, statutes and case law
- Strong computer skills and advanced knowledge of Microsoft products
- Bachelor's degree or higher
- 7 years liability claim handling experience (multi-jurisdiction preferred)
- 5 years bodily injury evaluation and negotiation experience (serious injury preferred)
- 5 years commercial general liability claim handling
- Condominium claim handling and ability to read and interpret condominium and property management documents preferred
- Licensed to adjust claims in Florida (multi-state licensing preferred)
Vacancy expired!