Job Description

Job Description:

Handle a caseload commensurate with the complexity level of claims assigned. Requires establishing

• Facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud, vendor management, reserve analysis, and report completion.
• Ability to attend conferences, client meetings, mentor other adjusters and assist management as needed.
• Ensure compliance with state statutes, client guidelines and NARS Best Practices.
• Address claim metrics in a timely and appropriate manner.
• Perform other miscellaneous duties as assigned, which may include travel.

Essential Duties and Responsibilities

• Coverage:
• Identify, analyze, and confirm coverage.
• Customer Service/Contact:
• Make contact first within parties and clients within eight (8) business hours.
• Communicate with parties and providers to determine liability, compensability, negligence, and subrogation potential.
• Obtain necessary information and explain benefits as appropriate. Maintain regular contact throughout the life of the claim process.
• Answer phones, check voice mail regularly, and return calls as needed.
• Assist with training/mentoring of Claims Adjusters.
• Assist management when required with projects or leadership as requested.
• Support management and handle various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence.

• Subrogation:
• Refer all files identified with subrogation potential to the subrogation department.
• Maintain closing ratio as dictated by management team.
• Close all files as appropriate in a timely and complete manner.

• Investigation:
• Verify facts of loss and pertinent claims facts such as employment, wages, or damages and establish disability with treating physicians as appropriate.
• Identify cases for settlement. Evaluate claims and request authority no later than 30 days prior to mediation date and negotiate settlement.
• Evaluate and negotiate liens.
• Recognize and report potential fraud cases.

• Litigation Management:
• Develop and direct a litigation plan with defense attorney (if assigned), utilizing all defenses and tools to bring the file to closure. Ensure all filings and state mandated forms are completed in a timely manner. Litigated files must be diarized effectively based on current activity, but no greater than every 60 days.
• Review claim files involving active litigation monthly at minimum, and document responses to filings, development of defenses, depositions, and timely referral to defense counsel.
• Direct the actions of defense counsel on litigated files.
• Attend mediations and trials as required for cost effective litigation management.

• Reserves:
• Establish ultimate reserves (anticipated cost to bring file to close based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Ensure timely payment of all known benefits in accordance with state statute.
• Verify all provider bills have been appropriately reviewed and paid within standard timeframes.

• Reporting Requirements:
• Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
• Must pass all internal and external audits, which include those performed by regulatory agencies, carriers, and clients.
• Follow reporting requests as outlined by client files and NARS guidelines.

Work Environment/Requirements

• This role requires extended periods of computer screen usage for tasks such as data entry, research, and virtual meetings.
• The ability to maintain focus and productivity while working for long hours in front of a screen is essential.

Qualification Requirements

• Education / Licensing:
• High School Diploma or equivalent required, 2-year degree or higher preferred.
• 5+ years of prior claim adjusting experience, preferably in the line of business being handled.
• Senior BI’s adjuster must have 5+ years heavy litigation experience for all other lines except Worker’s Compensation.
• Must possess, or can obtain, a Florida Adjuster’s license or other required jurisdictional licensing.
• Professional designations preferred.

• Technical Skills:
• Must have demonstrated advanced skills, a deep understanding of the claims process, and a proven ability to handle more complex cases for a significant period of time in the line of business being handled.
• Requires strong negotiation and litigation skills.
• Requires excellent interpersonal skills to handle sensitive and confidential situations and information.
• Requires ability to work independently.
• Requires excellent organization and time management skills.
• Requires exceptional written and verbal communication skills.

• Abilities:
• Requires long periods of sitting.
• Must be willing to attend local NARS office meetings, on occasion.
• Requires working indoors in environmentally controlled conditions.
• May require lifting of files and boxes up to approximately 20 pounds.
• Regular use of keyboard, mouse, computer.

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