About the role
Job Description
As a dedicated Sr. Injury Adjuster, you will be responsible to adjust attorney-involved, moderately complex claims or moderately complex to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.
Key Responsibilities
As a dedicated Sr. Injury Adjuster, you will be responsible to adjust attorney-involved, moderately complex claims or moderately complex to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.
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.
- 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.
- 4 or more years auto liability/casualty adjusting experience.
- 1 year or more experience in claims
- Ongoing professional development with a focus on Insurance
- Bachelor's degree or higher