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Job Summary
The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims.
Job Duties
- Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses.
- Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.
- Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
- Negotiate within settlement authority with insureds and claimants to resolve first and third party claims.
- Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
- Control expenses for areas of responsibility.
- Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
- Respond quickly to customer needs and problems.
- Independently resolve claims within authority level.
Qualifications
- Bachelors Equivalent combination of education and experience Preferred
- 7-9 years Prior claims handling experience. Preferred
- 4-6 years Property, Auto, Casualty or relevant claims administration experience. Required
- Comprehensive knowledge of claims administration best practices and procedures.
- Advanced knowledge of insurance, fault assessment, negligence and subrogation principles required.
- Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
- Advanced knowledge of Microsoft Office suite, general computer software and claims software.
- Advanced organization and planning recognition skills required.
- Advanced oral and written communication skills required.
- Advanced interpersonal skills required.
- Advanced leadership skills among peers required.
- Exhibit proficiency and understanding of medical terminology and causality
- Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
- Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
- Associate in Claims - Insurance Institute of America Preferred
- An insurance/claims adjuster license may be required for claims administration in specific states.
Scope
- Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.
- Provides resolution to a diverse range of recognizable complex problems. Analysis is required to identify root cause. Uses judgment within defined boundaries to develop alternate solutions, both long and short term. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but typically the majority of tasks take three to six months to resolve.
- Under general supervision, proceeds alone for regular duties, referring questionable cases to supervisor.
- Individual Contributor
- Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and/or achieve goals.
- Contacts are primarily within the department or function with occasional cross-functional interfaces. Some limited external customer contact on routine matters.
Remarkable benefits:
•   Health coverage for medical, dental, vision
•   401(K) saving plan with company match AND Pension
•   Tuition assistance
•   PTO for community volunteer programs
•   Wellness program
•   Employee discounts (membership, insurance, travel, entertainment, services and more!)
"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
AAA is an Equal Opportunity Employer
