Claims Adjuster - Liability

Duties:
Claimsexaminer #claims #hybrid #LI-Remote

Work Location: Tuesday/Wednesday in Office, Monday, Thursday & Friday Remote
They are open to fully remote but preference will be local candidates who can come into the office two days a week
Wed prefer candidates who have supported retail environments

Additional Job Description:
Primary Purpose:
To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities:
Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
Assesses liability and resolves claims within evaluation.
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
Manages subrogation of claims and negotiates settlements.
Communicates claim action with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintains professional client relationships.

Additional Functions and Responsibilities:
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

Skills:
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations

Education & Licensing:
Bachelor's degree from an accredited college or university preferred.
Four (4) years of claims management experience or equivalent combination of education and experience required.