理赔专员

Job Summary
This position is responsible for the oversight of complex and large exposure losses and will report to the
National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management,
providing direction and oversight ensuring that compliance with best practices and state/local guidelines
is achieved. In addition, this position will report findings and make recommendations on current practices
including the claim department’s performance on meeting regulatory standards.
Job Responsibilities

• Review home office casualty files, provide direction as required to ensure that handling is within

best practice guidelines and local jurisdiction regulations.

• Responsible for providing guidance and direction to claims staff in order to ensure proper

handling and risk mitigation.

• Provide authority and guidance on all bodily injury claims regarding coverage, liability and

damages, as required.

• Provide feedback to leadership and adjusting staff as required for continually improved file

handling.

• Responsible for collaboration with claims staff, front line claims management, senior claims

management and legal counsel.

• Available to answer questions and participate in roundtable discussions with claims staff and

management to provide feedback and guidance on claim handling procedures.

• Complete research pertaining to complex coverage issues, industry trends, and related topics.

• May assist with targeted audits of a particular process or function (e.g. total loss handling, BI

evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management
re-audits to verify calibration and accuracy of the first level reviews completed.

• Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling

Job Qualifications
Formal Education & Certification
Bachelor’s degree or equivalent work experience
Knowledge & Experience

• A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty

claims with high complexity.

• Prior claims management experience and/or auditing preferred.

Skills & Competencies

• Communication and analytical ability at a level to interact with associates, managers, agents and

vendors.

• Demonstrated team building and coordination skills.

• Must possess strong interpersonal skills and the ability to present critical information to Senior

Management.

• Ability to manage multiple priorities and work independently.

• Leadership abilities are necessary, with the ability to make autonomous decisions based on

multiple facts.

• Must be able to work in a fast-paced automated production environment and possess

solid planning and organizational skills including time management, prioritization, and
attention to detail.

• Must meet company guidelines for attendance and punctuality and professional

appearance/decorum.
This job description indicates the essential responsibilities of the job. The duties described are not to be
interpreted as being all-inclusive to any specific associate. Management reserves the right to add to,
modify, or change the work assignments of the position as business needs dictate. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions of
the job. This job description does not represent a contract of employment. Employment with
AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without
reason or notice by either the employer or the associate.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Originally posted on Himalayas