Extensive knowledge of policy documents and legal contract interpretation.
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.
Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes
and case law to determine if a claim can be accepted as being within coverage.
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.
Identifies and investigates pre-existing medical documentation.
Knowledge of both property and casualty adjusting software and able to review estimates for
Comply with all statutory and regulatory requirements of all applicable jurisdictions.
Meet detailed quality assurance standards and meet set goals of performance.
Set and revise case reserves in accordance to the reserving policy.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third
Accountable for the 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 team
Strong problem structuring and quantitative problem solving skills
The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree
or equivalent experience and at least 7+ 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
BS / BA Degree preferred
Advanced studies or insurance designation preferred