Senior Claims Adjuster

Job Summary

The Senior Property & Casualty Claims Adjuster is responsible for managing, investigating, evaluating, negotiating, and resolving complex property and casualty insurance claims. This role requires advanced technical claims knowledge, strong coverage analysis skills, sound judgment, and the ability to handle high-exposure or litigated claims with minimal supervision. The Senior Claims Adjuster serves as a subject matter expert, providing guidance to junior adjusters, collaborating with internal and external stakeholders, and ensuring claims are handled in accordance with company policies, regulatory requirements, and industry best practices.

Responsibilities

Claims Investigation and Evaluation:

• Investigate complex property and casualty claims, including auto, general liability, property damage, bodily injury, premises liability, and other related claims
• Review policy language, endorsements, exclusions, and applicable coverage to determine liability and claim validity
• Gather and analyze claim documentation, including statements, police reports, medical records, repair estimates, appraisals, photographs, expert reports, and legal documents
• Conduct interviews with insureds, claimants, witnesses, attorneys, vendors, and other relevant parties
• Assess liability, damages, coverage, and exposure to determine appropriate claim strategy

Claims Management and Resolution:

• Manage a caseload of complex, high-value, or litigated claims from initial assignment through resolution
• Establish and maintain accurate reserves based on claim exposure, coverage, liability, and damages
• Negotiate settlements with claimants, attorneys, insureds, and other parties within assigned authority limits
• Identify opportunities for early resolution while protecting the company's financial and legal interests
• Ensure timely and accurate claim payments, denials, or settlements
• Prepare detailed claim reports, coverage position letters, settlement evaluations, and litigation updates

Litigation and Vendor Management:

• Work closely with defense counsel, coverage counsel, experts, appraisers, engineers, investigators, and other vendors
• Provide direction to legal counsel on claim strategy, discovery, settlement negotiations, mediation, arbitration, and trial preparation
• Attend mediations, settlement conferences, hearings, or trials as needed
• Monitor legal expenses and vendor performance to ensure cost-effective claim handling

Compliance and Documentation:

• Ensure all claims are handled in compliance with state insurance regulations, fair claims practices, company standards, and applicable laws
• Maintain accurate, timely, and thorough claim file documentation
• Meet internal performance standards related to quality, timeliness, customer service, and regulatory compliance
• Identify and escalate