Sr. Injury Adjuster

Job Description

As a dedicated Sr. Injury Adjuster, you will be responsible to adjust attorney-involved, moderately complex claims or moderately complex to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.

Key Responsibilities:

Adjusts attorney-involved soft tissue and moderately complex claims with injuries (e.g., torn meniscus, broken bones, disc herniations) and claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on soft tissue and moderately complex bodily injury 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. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Must Have Qualifications:

High School Diploma or General Equivalency Diploma. 2 years of auto claims adjusting experience. 1 year of injury adjusting experience with attorney represented claims, 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.

Nice to Have Qualifications

4 or more years auto liability/casualty adjusting experience. 1 year or more experience in claims Ongoing professional development with a focus on Insurance Bachelors degree or higher

 

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