复杂索赔主调整员

Job Summary
The Complex Claims Master Adjuster works within highest limits and authority on highly complex claim assignments. The role is responsible for the appropriate resolution of complex claims representing the highest levels of exposure and expense to the organization. The role determines coverage, investigates, analyzes, negotiates, and settles the highest and most complex claims with high corporate visibility and/or significant exposure. The role also empowers and leads claims adjusters to achieve claims management excellence, directly handles the largest and most complex claims, serving as a technical consultant and subject matter expert to business partners.
Job Responsibilities

• Determines whether coverage exists for the type of complex claim assigned and investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution.

• Selects, directs, and supervises internal and external resources and experts impacting short and long-term claim results.

• Maintains effective and ongoing communication with claims staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, claims leadership, vendors/contractors, and public adjusters.

• Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience and completes appropriate reports so that the status of the claim is clearly always documented.

• Negotiates timely and appropriate settlements with insureds, claimants, vendors, attorneys, and other insurance companies and refers claims exceeding authority to appropriate leader with recommendations.

• Remains current on industry topics, trends, processes, technology, best practices through research, industry events, networking, etc.

• Assists less experienced claims professionals in the handling of large or complicated losses and actively participates in the coaching, development, training, and education of claims professionals.

• Participates in large/complex exposure file analysis and strategy development via roundtable discussions.

• Travels as often as needed including regular utilization of assigned fleet vehicle to cover assigned territory. May involve traveling on short notice or other daily driving duties as assigned regardless of location.

Job Qualifications

• 10+ years of Complex Claims handling experience.

• Bachelor's degree in Business Administration or related field and/or commensurate work experience.

• Valid driver’s license and a driving record that conforms to company standards.

Location
Remote
Licenses and Certifications

• Chartered Property Casualty Underwriter (CPCU) (Preferred)

• Associate in Claims (AIC) (Preferred)

Behavioral Competencies

• Collaborates

• Communicates Effectively

• Customer Focus

• Decision Quality

• Nimble Learning

Technical Skills

• Claims Adjustment

• Claims Evaluation

• Claims Investigation

• Claims Management System

• Insurance Industry Knowledge

• Business Process Improvement

• Financial controls

• Claims Case Management

• Data Analysis and Reporting

• Cost Optimization

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.
Originally posted on Himalayas