Job Description:

• Handle a caseload of approximately 130 pending claims that encompass all levels of complexity.
• Requires establishing facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud and appropriate use of authorized vendors.
• Also includes timely and appropriate reserve analysis and report completion.
• Ability to attend conferences, client meetings, mentor other adjusters and assist management as requested.
• All file handling must be within state statutes,
• Client Claims Handling Guidelines and NARS Best Practices.
• Other miscellaneous duties as assigned, which may include travel.
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Essential Duties and Responsibilities:

• Coverage: Identify, analyze and confirm coverage.
• Customer Service/Contact:
  • Contact appropriate parties and providers to determine liability, compensability, negligence and subrogation potential.
  • Contact appropriate parties to obtain any needed information and explain benefits as appropriate.
  • Continue contact throughout the life of the file as appropriate.
• Answer phones, check voice mail regularly, and return calls as needed.
• Assist with training/mentoring of Claims Adjusters.
• Assist management when required with projects or leadership as requested.
• Handle the various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence.
• Subrogation: 
  • Refer all files identified with subrogation potential to the subrogation department.
• Investigation: •
  • Verify facts of loss and pertinent claims facts such as employment, wages, or damages and establish disability with treating physicians as appropriate.
• Identify cases for settlement.
• Evaluate claims and request authority no later than 30 days prior to mediation date and negotiate settlement.
• Evaluate and negotiate liens.
• Recognize and report potential fraud cases.
• Litigation Management: •
  • Develop and direct a litigation plan with defense attorney (if assigned), utilizing all defenses and tools to bring the file to closure.
  • Ensure all filings and state mandated forms are completed timely.
  • Litigated files must be diaried effectively based on current activity, but no greater than every 60 days. •
• Review claim files involving active litigation on a monthly basis at minimum, and document responses to filings, development of defenses, depositions, and timely referral to defense counsel.
• Direct the actions of defense counsel on litigated files.
• Attend mediations and trials as required for cost effective litigation management.
• Reserves: 
  • Establish ultimate reserves (anticipated cost to bring file to close based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Pay all known benefits, ensuring they are paid timely on state statute.
• Verify all provider bills have been appropriately reviewed and paid within standard timeframes.
• Reporting Requirements:
  • Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
• Must pass all internal and external audits, which include those performed by regulatory agencies, carriers, and clients.
• Follow reporting requests as outlined by client files and NARS guidelines.
• Resolution:
  • Document plan of action in the claim system and set appropriate diaries.
• Maintain a regular diary for monitoring and directing medical care, case development, or litigation.
• Close all files as appropriate in a timely and complete manner.
• Maintain closing ratio as dictated by management team.

Qualification Requirements:

Education / Licensing:

• High School Diploma, college degree preferred.
• Must have 3+ years prior claim adjusting or similar experience, with the majority handling complex litigation.
• Must have 5 to 7 years of overall claims experience, preferably in the line of business being handled.
• Must have 5+ years heavy litigation experience for all other lines except workers compensation.
• Must have 3+ years Construction Defect or similar/related experience if handling that line of business.
• Must be eligible for reserve/payment authority level of $50,000+ when appropriate
• Must possess, or have the ability to obtain, a Florida Adjuster’s license or other required jurisdictional licensing.

Technical skills:

• Advance level of interpersonal skills to handle sensitive and confidential situations and information.
• Requires advanced ability to negotiate claims and to direct litigation.
• Must have negotiation and litigation skills for significant work with attorneys and arbitration on first and third party claims.
• Requires advanced ability to work independently.
• Requires an advanced level of organization and time management skills.
• Must possess advanced level written and verbal communication skills.
• Must be able to explain and appropriately respond to auditors, clients, and potential clients during in-person presentations.

Abilities:

• Requires long periods of sitting.
• Requires working indoors in environmentally controlled conditions.
• Requires lifting of files and boxes up to approximately 20 pounds.
• Repeated use of a keyboard, mouse, and exposure to computer screens.
• Requires travel as assigned, which can at times be extensive (5 to 7 days per month).

General Information: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. This description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The incumbent must be able to work in a fast-paced environment with demonstrated ability to handle multiple, competing tasks and demands and to seek supervisory assistance when necessary.