Claims Adjuster

Description

The Claims Adjuster investigates, evaluates, and adjusts General and Automobile Liability claims. Although assigned claims generally consist of low to medium exposure, first and third-party automobile bodily injury and property damage claims, as well as premises liability accidents, product liability claims, the claims adjuster must be qualified legally and technically to handle all claims competently.

Requirements

Primary responsibilities :

Based on the area of responsibility, the employee shall be asked to all of the following essential functions :

• Investigate, analyze, and determine the extent of insurance provider's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants.
• Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.
• Investigate claims :
• Assess and estimate vehicle damage.
• Assist with business or managerial research.
• Compile information through interviews.
• Evaluate customer records.
• Examine evidence to determine if it will support claims.
• Follow contract, property, or insurance laws.
• Follow rules of evidence procedures in legal setting.
• Gather physical evidence.
• Inspect property to determine damages.
• Research property records.
• Search legal records Interviews, telephones, and or corresponds with claimant and witnesses.
• Evaluate liability exposure :
• Review insurance applications.
• Review insurance policies to determine appropriate coverage.
• Obtain, review and evaluate records, police, medical, etc.
• Recommend claim action.
• Properly reserve for the claim.
• Adjust reserve as appropriate.
• Comply with accepted guidelines regarding reserving practice and authority levels.
• Create and maintain records
• Maintain records, reports, and files which are primarily found on the SIMS and / or Renaissance system.
• Maintain all cases on an active diary on the SIMS and / or Renaissance system pursuant to established Company criteria.
• Prepare timely reports to clients.
• Comply with all reporting requirements / steps set out in the GHC Procedure Manual.
• Comply with regulatory requirements.
• Diary spoken or written information.
• Litigation management support :
• Collect evidence to support contested claims in court.
• Keep clients advised.
• Other duties as assigned.

Requirements

Education and Experience

• Bachelor’s degree preferred.
• At least three (3) years of experience with insurance claims, self-insurance, pooled insurance, or Joint Powers Authorities.
• Possess comprehensive knowledge relating to the handling of public entity liability claims.
• At least three (3) years of using Microsoft Windows on a PC including Microsoft Word, Excel, Outlook and Powerpoint.
• At least two (2) years of using streaming video conferencing including Teams and Zoom with the ability to set and host group meetings with all included functionality.
• At least two (2) years of using claims management software and / or ability to quickly learn new software systems related to claims management.
• Excellent written and verbal communication skills.

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