The Liability Claims Adjuster will investigate coverage and determine liability for assigned third party liability claims. Once coverage has been confirmed, the adjuster with make a liability determination using the applicable state rules governing the comparative fault and contributory negligence laws of the state. The in-depth investigations required may involve multifaceted elements of assigned claims. Strong investigate skills are required, in order to make a coverage determination and subsequent damage evaluation, once coverage is accepted. The ability to promptly analyze and prepare action plans and present to the claim manager, based on multiple data sources is required. Knowledge of FL, GA, AL, SC and NC insurance regulations, claims practices and statutory requirements, governing state specific case law. Settlement of claims may involve ADR methodology, mediation and disputed claims resolution. The Complex Claims Adjuster will also serve as a mentor to less experienced adjusters and assist with training, as needed. A competitive candidate will have a high level of technical competence, attend training, assist management with other duties and work collaboratively with co-workers.
- Verify facts of loss and pertinent information to analyze and confirm coverage
- Handle the adjusting of the entire claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make coverage recommendation and issue payments within applicable authority level.
- Contact insured(s) to schedule inspections, take recorded statements, obtain photos, copy of available videos, etc. in a timely manner.
- Keep insured(s) informed on all steps of the claim investigation and progress to resolution.
- Determine the method and extent of investigation for each claim. Make assignment to outside experts or investigators when appropriate.
- Review and analyze all investigative and claim material to determine the facts of the loss, in a timely manner.
- Document all claim actions, inclusive of coverage and damage investigations, contacts, phone calls, emails and correspondences in the claim file.
- Check e-mails and messages daily. Respond to all calls, emails and questions in a timely manner.
- Establish ultimate reserves (anticipated cost to bring file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
- Explain and appropriately respond to insureds, public adjusters, attorneys, contractors and any additional involved parties to obtain needed information, complete a timely investigation, relay status updates, explain settlements and/or ultimate claim disposition.
- Timely submit reserve and payment approval requests, as appropriate.
- Attend mediations, as assigned, and apply technical knowledge to facilitate claim resolution negotiations.
- Apply advanced negotiation skills to effectuate direct resolution of disputed claims with insureds or their legal representative.
- Identify claims requiring a Reservation of Rights or denial, draft appropriate coverage correspondence and refer to management for approval
SUPERVISORY RESPONSIBILITIESThis job has no supervisory responsibilities. Adjuster will work with administrative assistants to accomplish claim tasks.
Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy. Attention to detail. Ability to multi-task. Effective oral, written, organizational and analytical skills required. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level if internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Maintain Florida 520 License. Obtain Alabama, North Carolina, South Carolina and Georgia licenses if applicant does not currently possess same.
EDUCATION AND/OR EXPERIENCE
Minimum of 8 years’ experience handling complex liability claims. Ability to regularly use computer and certain software programs. Ability to effectively direct experts and attorneys as required by the specific claim. A four-year college degree is preferred.
CERTIFICATES, LICENSES, REGISTRATIONS
Preferred, not required
Must possess the ability to read and comprehend detailed instructions, correspondence, and memos as well as write correspondence. Must also be able to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Must be proficient with the following: addition, subtraction, multiplication, and division in all units of measure, using whole numbers, common fractions, and decimals.
Must be able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Must also be able to deal with problems involving several concrete variables in standardized situations.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
NOTE: This is not necessarily an exhaustive list of responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, Frontline Insurance reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed when circumstances change.
We are a Drug Free Workplace and EOE.