Claims Adjuster – Liability

Claims Adjuster – Liability

Requirements

• Bachelor’s degree from an accredited college or university preferred
• Four (4) years of claims management experience or equivalent combination of education and experience required
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

Responsibilities

• Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
• Assesses liability and resolves claims within evaluation
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
• Manages subrogation of claims and negotiates settlements
• Communicates claim action with claimant and client
• Ensures claim files are properly documented and claims coding is correct
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
• Maintains professional client relationships
• Performs other duties as assigned
• Supports the organization’s quality program(s)
• Travels as required

Preferred Qualifications

• Bachelor’s degree from an accredited college or university preferred