Claims - Case Manager 2

Job Description

• Position Summary...

What you'll do...

• Minimizes legal exposure by securing services of outside legal counsel; attending and participating in arbitrations; auditing and paying outside counsel invoices; assessing the impact claim may have on case law and precedent prior to making claim payment; and structuring complex settlements.
• Manages interpretation of medical reports and case information; reviewing records for preexisting conditions; referencing applicable case law/statutes; and presenting claim reviews and decisions to senior management for approval or guidance.
• Manages complex cases involving alleged bodily injury, personal injury, and property damage by interviewing key witnesses; securing evidence; analyzing evidence; reviewing applicable laws; interpreting medical reports; deducing causes and responsibilities; documenting case details; determining whether payment is warranted; and managing multiple claims related to a single event as required.
• Drives claim investigations by conducting ongoing medical and legal reviews; commissioning field investigators, re-constructionists, and cause and origin specialists to determine claim origination; managing media exposure during investigations; synthesizing information from outside counsel; and reviewing, documenting, and indexing information received on each claim in the claim/image management system.
• Manages monetary aspects of assigned claims by establishing reserves within approval level; notifying store managers of significant reserve increases; monitoring reserves for all open claims; authorizing payment for approval or facilitating denial of the claim; and reserving file for payments that exceed authority for manager and serious case review.
• Manages negotiations with customer, customer's attorney, or third party to resolve claims by sharing investigative results and rationale; citing legislation that supports decision; listening to claimant perspective and arguments; influencing claimant's perspective; and coming to consensus on appropriate and final resolution.
• Coordinates, completes, and oversees job-related activities and assignments by developing and maintaining relationships with key stakeholders; supporting plans and initiatives to meet customer and business needs; identifying and communicating goals and objectives; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; and demonstrating adaptability and promoting continuous learning.
• Provides supervision and development opportunities for associates by hiring and training; mentoring; assigning duties; providing recognition; and ensuring diversity awareness.
• Ensures compliance with company policies and procedures and supports company mission, values, and standards of ethics and integrity by implementing related action plans; utilizing and supporting the Open Door Policy; and providing direction and guidance on applying these in executing business processes and practices.

Minimum Qualifications...

Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Bachelor's degree OR 2 years’ experience in insurance claims or related area.
Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date

Preferred Qualifications...

Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.

Settling claims and customer service