Sr. Injury Adjuster

Key Responsibilities

• Adjusts attorney-involved soft tissue and moderately complex claims with injuries (e.g., torn meniscus, broken bones, disc herniations) and claims, as well as some auto physical damage associated with those claims.
• Identifies, confirms, and makes coverage decisions on soft tissue and moderately complex bodily injury claims.
• Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.
• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.
• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.
• PARTNERS WITH AND/OR DIRECTS VENDORS AND INTERNAL BUSINESS PARTNERS TO FACILITATE TIMELY CLAIMS RESOLUTION.
• DELIVERS A BEST-IN-CLASS MEMBER SERVICE EXPERIENCE BY SETTING APPROPRIATE EXPECTATIONS AND PROACTIVE COMMUNICATION.
• SUPPORTS WORKLOAD SURGES AND CATASTROPHE (CAT) RESPONSE OPERATIONS AS NEEDED, INCLUDING MANDATORY ON-CALL DATES AND POTENTIAL EVENING, WEEKEND, AND/OR HOLIDAY WORK OUTSIDE NORMAL WORK HOURS.
• MAY BE ASSIGNED CAT DEPLOYMENT TRAVEL WITH MINIMAL NOTICE DURING DESIGNATED CATS.
• WORKS VARIOUS TYPES OF CLAIMS, INCLUDING ONES OF HIGHER COMPLEXITY, AND MAY BE ASSIGNED ADDITIONAL WORK OUTSIDE NORMAL DUTIES AS NEEDED.
• ENSURES RISKS ASSOCIATED WITH BUSINESS ACTIVITIES ARE EFFECTIVELY IDENTIFIED, MEASURED, MONITORED, AND CONTROLLED IN ACCORDANCE WITH RISK AND COMPLIANCE POLICIES AND PROCEDURES.

Qualifications

• High School Diploma or General Equivalency Diploma.
• 2 years of auto claims adjusting experience.
• 1 year of injury adjusting experience with attorney represented claims.
• Proficient knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.
• Proficient negotiation, investigation, communication, and conflict resolution skills.
• Demonstrated time-management and decision-making skills.
• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.
• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.
• Ability to exercise sound financial judgment and discretion in handling insurance claims.
• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.
• Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.