Claims Adjuster

Responsible for the assignment and handling of complex multi-line or discipline-specific insurance claims which include coverage analysis, investigation, evaluation, negotiation, settlement, salvage, and subrogation.

Adjudicates claims within assigned settlement authority and adheres to applicable laws, regulations, and company guidelines.

ESSENTIAL DUTIES : The following duties are representative of those required for this position. All of the duties may not be required, and additional duties may be assigned.

• Performs complex claim handling duties as assigned within the property, liability, casualty, or auto discipline.
• Conducts on-site field investigation and assessment of reported claims as needed and assigned.
• Documents the claim file in a prompt, clear, and concise manner, with the facts gathered in the investigation.
• Evaluates coverage, gathers evidence and documentation, and determines whether coverage is applicable for assigned losses.
• Establishes, evaluates, and maintains individual case reserves in accordance with the Claims Department Reserving Philosophy.
• Negotiates fault and damages with insureds, claimants, adverse carriers, attorneys, or other involved parties.
• Determines value of covered damages, and adjudicates the claim within their authority level, or presents valuation evidence to the Claims Supervisor for additional authority as needed, while maintaining compliance with applicable laws, regulations, and company guidelines.
• Coordinates with outside vendors and experts for attorney services, fire cause and origin, professional engineering services (structural, mechanical, and electrical), estimate reviews, accident reconstruction, medical bill reviews, appraisal services, and official reports.
• Performs and assists with subrogation and salvage recovery efforts, to include identifying recovery potential, and / or pursuing liable tortfeasor or other insurance carriers, as warranted.
• Prepares detailed, technical, written correspondence to communicate investigation, findings, policy application, or other activities involved in the adjudication of a claim.
• Attends and participates in Alternative Dispute Resolution, Examinations Under Oath, or any legal proceedings up to and including trial.
• Directly handles and / or assists with storm and catastrophe losses as needed.
• Provides excellent customer service to all external and internal customers, and maintains good working relationships with field and Home Office personnel.
• Performs other duties as assigned.

EDUCATION and / or EXPERIENCE

Claims Representative Bachelor’s Degree required, except that additional related work experience may be substituted on a year-for-year basis for the formal education requirement.

QUALIFICATIONS

• Ability to operate a personal computer and standard office equipment.
• Ability to learn and operate claims-related software.
• Consistently delivers accurate, clear and concise messages orally and / or in writing
• Ability to handle a high volume of detailed work accurately and completely.
• Ability to research and compile information and exercise good judgment.
• Engages in continuous learning opportunities to further develop skills and capabilities in procedures and principles
• Consistently presents a calm, competent, and professional image to the public and other MOFB employees
• Takes responsibilities seriously and consistently meets MOFB’s expectations for quality, service, and professionalism
• Co-operate with team members to contribute to the achievement of MOFB’s goals and mission

CERTIFICATES, LICENSES, REGISTRATIONS

Valid Missouri Driver License required.