Complex Claims Specialist
2 Days Old
About This Opportunity
Remember to check your CV before applying Also, ensure you read through all the requirements related to this role.
As a Sr. Injury Adjuster, you will be responsible for adjusting complex bodily injury claims and UM claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations.
This is a hybrid role that requires you to be in the office 3 days per week. The position can be based in one of several locations including San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Chesapeake, VA or Tampa, FL.
You will work within defined guidelines and framework to adjust attorney-involved, moderately complex bodily injury claims, and UM claims. You will also be responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.
Responsibilities
Adjusts attorney-involved and non-represented soft tissue and moderately complex bodily injury claims with injuries (e.g., torn meniscus, broken bones, disc herniations) and UM/UIM claims, as well as some auto physical damage associated with those claims.
Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.
Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.
Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.
Partners with and/or directs vendors and internal business partners to facilitate timely claims resolution.
Delivers a best-in-class member service experience by setting appropriate expectations and proactive communication.
Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
May be assigned CAT deployment travel with minimal notice during designated CATs.
Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
Requirements
High School Diploma or General Equivalency Diploma.
2 years of auto claims adjusting experience.
1 year of injury adjusting experience.
Proficient knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.
Proficient negotiation, investigation, communication, and conflict resolution skills.
Demonstrated time-management and decision-making skills.
Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.
Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.
Ability to exercise sound financial judgment and discretion in handling insurance claims.
Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.
Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
Preferred Qualifications
4 or more years auto liability/casualty adjusting experience.
1 year or more experience in Uninsured motorist (UM) claims
Ongoing professional development with a focus on Insurance.
Bachelors degree or higher.
Benefits
We offer comprehensive medical, dental, and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs.
Additionally, our career path planning and continuing education assists employees with their professional goals.
- Location:
- COLORADO SPRINGS