Casualty Claims Adjuster II

About the role

This position is eligible to work from home anywhere in the United States.

Responsibilities

• Investigates and evaluates moderately complex auto and casualty claims, confirming coverage, deductibles, and payees against policies and regulations
• Initiates timely contact with insureds, claimants, and witnesses to explain the process and gather statements
• Collections, reviews, and documents investigative reports, claim forms, and supporting materials in the claims system
• Maintains accurate claim documentation, including activity logs, report summaries, and reserve analysis (including Medicare/MSP)
• Establishes and adjusts timely, appropriate reserves in line with company methodology
• Identifies and pursues subrogation and recovery opportunities, ensuring proper evidence handling and compliance
• Ensures adherence to state regulatory requirements, including timely issuance of required communications and forms
• Manages low-complexity litigated files, including recommending and coordinating defense counsel assignments
• Oversees and evaluates vendors, invoices, and expenses for accuracy, appropriateness, and cost-effectiveness
• Drafts coverage determinations, including reservation of rights and denial letters with appropriate approvals
• Provides clear, timely status updates to agents, insureds, and claimants and escalates issues as needed
• Evaluates liability and damages, prepares negotiation strategies, resolves liens (including Medicare), and negotiates settlements
• Finalizes settlements, including documentation, releases, payments, and participation in mediations or arbitrations
• Collaborates cross-functionally (SIU, Subrogation, Legal, Underwriting, Risk) while contributing to team support, training, and projects

Requirements

• Bachelor’s degree or equivalent relevant experience
• Three years of casualty claims adjusting experience or related experience
• Relevant insurance designations preferred

Qualifications

• 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
• Adherence 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
• Maintain confidentiality

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

Benefits

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws. All of our locations are tobacco free including in company vehicles.

Pay

The hiring salary range for this position will vary based on geographic location, falling within either of the following: $60,813 - $84,038 or $67,200 - $92,395

Schedule

N/A