Extensive knowledge of policy documents and legal contract interpretation.
Working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management.
Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels. Recommends ultimate resolution on assigned cases in excess of their authority to local claims management.
Litigation handling experience in both General Liability and Casualty files.
Proven ability to drive litigation, attend mediations, trials, and other alternative dispute resolution avenues.
Communicates with policyholders, witnesses, and claimants, in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to the proper course of action.
Responds to various written and telephone inquiries including status reports.
Present file materials for authority and roundtables.
Work with nurses, doctors, and attorneys on file reviews.
Comply with all statutory and regulatory requirements of all applicable jurisdiction.
Meet detailed quality assurance standards and meet set goals of performance.
Set and revise case reserves in accordance with the reserving policy.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Work with and provide claim-specific guidance to Independent Field Adjuster.
Partner closely with internal teams and advise leadership of key claim activities and exposures.
The capabilities, skills, and knowledge required is normally acquired through a Bachelors degree or equivalent experience and at least 13+ years of directly related experience.
Strong written and oral communication skills required as well as strong interpersonal, analytical, investigative, and negotiation skills.
In-depth knowledge of multi-jurisdictional claims handling issues
Candidates must have, or be able to promptly obtain a Texas Independent Adjuster License
Effective communication, presentation, negotiation, and persuasion skills.
Ability to collaborate with cross-functional teams to achieve business results.
Proven success delivering in rapidly changing claims environment.
Achieves a standard of excellence with work processes and outcomes, honoring company policies and regulatory compliance.
Team oriented, building strong working relationships and a positive work environment.
Is receptive to feedback and willing to learn, embracing continuous improvement.
Travel capability, up to 10% of work time, is required.
BS / BA Degree preferred
Advanced studies or insurance designation preferred