Posted on Nov 17, 2018 by Shelter Insurance
A company built to serve you. It's your career, Shelter it!
The Casualty Adjuster investigates, analyzes, evaluates and settles insurance claims involving liability issues and bodily injury losses. Performs complete liability, coverage, and bodily injury investigations. Determines validity of claims, verifies coverage, establishes value of losses and negotiates settlements within limits of authority, consistent with established procedures and legal and contractual obligations. Coordinates claims handling of multiple adjusters. Due to the duties and responsibilities of this position, consumer reports may be ordered on final candidates. College degree from an accredited college or university, or equivalent job-related experience is required. Requires the ability to perform the essential functions of the position with or without a reasonable accommodation.
Minimum starting salary: $18.69 - $30.76 per hour
If interested, please apply by:
- Reviews assigned loss reports to determine extent of investigation and additional information needed. Reads, analyzes and interprets insurance policies and endorsements, applicable state and local statutes, case law, bulletins/decisions and applies to claims situations. Applies read-in/read-out approach to determine policy coverage. Verifies coverage limits, effective dates and possible restrictions or exclusions.
- Investigates to establish the facts of claim, including evaluation of coverage, liability, and injuries. Orders police reports and other records from ISO database and other sources to determine facts and prior accident information.
- Reviews and evaluates claim based on evidence obtained in investigation. Determines responsible parties and makes decisions regarding Company liability, questions of fraud or other pertinent issues. Sets and adjusts reserves.
- Requests medical authorization from injured parties and submits claimant information to ISO database. Orders bills and reports from medical providers of injured parties, and medical histories as needed.
- Examines and reviews potential subrogation claims and pursues subrogation according to Company guidelines. Obtains other party information to determine Shelter's subrogation rights. Prepares files for arbitration.
- Prepares and maintains file documentation. Takes recorded statements as needed.
- Communicates with outside vendors, expert consultants, and attorneys. Attends mediation on appropriate files. Assists in first and third party litigation as needed.
- Gives written notice to claimants, insureds and legal counsel of denied claims. Handles claims on minor children and wrongful death including those sent to outside counsel.
- Reviews open files on a regular basis and makes contact with insureds, claimants or representatives to determine progress of claim. Documents pending files in writing concerning activities and reviews with supervisor on a regular basis.
- Negotiates settlement of claims with insureds, claimants and others up to authority limits.
- Coordinates assignment of claims to other adjusters, provides training for other adjusters, and may serve on committees as needed. Assists Claims Litigation in handling investigation and settlement of Agent Errors and Omissions claims. Assigns to outside counsel and monitors claims involved in the court approval process.
- Provides support to agency force, including policy interpretation, training and general understanding of Claims operations. Assists Underwriting by utilizing Risk Alerts and investigating material misrepresentations on applications.
- May be responsible for evaluating physical damage estimates and paying physical damage claims.
- Must be able to safely operate an automobile, telephone, fax machine, copy machine, digital camera, personal computer and miscellaneous office equipment. Resident adjusters must have high-speed Internet access (via DSL or cable modem) from their residence.
- Performs other duties as requested by Branch Claims Supervisor or Branch Claims Manager.
- Requires excellent investigative, analytical, organizational, and decision-making skills.
- Superior skills in negotiation, communication and customer service are required.
- Ability to learn through on-the-job training and claims training courses related to the study of insurance policy coverage analysis and interpretation, investigative procedures, medical terminology, injury causation and treatment methods.
- Must possess a valid driver's license supported by a good driving history.
- Must be able to travel overnight as job requires.
- Must exhibit strong skills in technology to include keyboarding and familiarity with word processing software, electronic communications, and Internet research capabilities.
- Ability to maintain schedules and deadlines and work well with others.
- This is the skill set for an individual at mid point of position. Based upon banding of grades, the skills needed may vary.
- College degree from an accredited college or university, or equivalent job-related experience, is required.
- Requires good basic but advancing knowledge of medical terminology. May require basic knowledge of automobile repair.
- A minimum of two years general business experience is preferred in an insurance setting, demonstrating experience in organization, communication, negotiation and decision-making.
- Responsible for handling claims with accuracy and consistency, following established procedures and authority limits, policy language and provisions, and applicable state and local statutes.
- Responsible for promptly and accurately examining details of each claim assigned and making sound decisions with regard to investigation, gathering of information, and payment or denial in accordance with policy, procedural, and statutory requirements.
- Responsible for properly recording data to claims system to ensure claims are appropriately paid and recorded for statistical data.
- Responsible for reviewing assigned claims on a regular basis and accountable for maintaining accurate reserves.
- Responsible for maintaining a high level of technical knowledge required for accurate, timely and efficient claims handling.
- May be required to acquire and maintain state licenses as applicable.