Job description
- Adjust a caseload of assigned files in accordance with AmeriTrust’s policies and procedures.
- Maintain an active diary on 100% of caseload files, with a current plan of action.
- Adhere to assigned authority limits for reserving and payments (including settlements).
- Receive claim assignments from Claim Manager or Supervisor on losses, injuries and/or damages ranging from minor to moderate.
- Determine coverage and the extent of liability or the compensability present with each claim.
- Verify coverage, investigate the loss by gathering all pertinent information, evaluate the claim, set reserves, negotiate settlements or deny payments where no overage, liability or compensability exists.
- Record statements, obtain documentation such as police reports, medical reports, appraisals, estimates, photographs, etc. to process claims in accordance with Company standards.
- Evaluate loss, assess reserve and settlements value where applicable and settle cases with claimants, insureds and attorneys autonomously.
- Decide on declination of coverage, liability or compensability and convey denials in a professional manner.
- Identify and thoroughly investigate all possible recovery and subrogation opportunities revealed in the claims handled. (Claims Representative and/or Recovery Partner)
- Respond to all treating physician and attorney requests in a timely manner.
- File all state and/or federal forms, filings and reports in accordance with the statutory Guidelines.
- Exercise independent decision-making with moderate supervision and directions on claims assigned and will have a working knowledge of local codes, laws, standards and case law.
- Return all telephone calls within one (1) business day of receipt. All messages from customers and agents are to be returned by the end of the same business day in which the call was received, when possible. Reports all service complaints to Claims Supervisor or Claims Manager immediately upon receipt.
- Maintain personal compliance with all continuing education requirements as mandated by statute or by office policy.
- Manually or electronically document files in a timely fashion with all appropriate information, in a legally accepted, factual manner.
- Understand coverage issues with good knowledge of exclusions, endorsements on standard ISO forms.
- Negotiate settlement based upon scope, estimate, coverage interpretations, accident scene investigation and income statements developed.
- Work with / vendor manage, Independent Appraiser / Experts through preliminary scene investigation, fire scenes, accident scenes and/or burglary losses.
- Professional and timely communication with all internal and external customers.
- Must adhere to the company code of ethics.
- Performs related duties as assigned.
- Ability to interact with others in a professional manner
- Attendance
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED TO PERFORM ESSENTIAL FUNCTIONS:
- Prior Admitted and non-admitted Auto, Garage & General Liability experience required.
- A Bachelor's Degree in Risk Management & Insurance, Business Administration, Finance or similar. Equivalent education, experience, and skills may also qualify.
- A minimum of one (1) year of adjusting experience or equivalent experience.
- Ability to acquire a valid State adjusting license when and where applicable.
- Ability to prioritize daily workflow of a moderate technical complexity.
- Excellent written and oral communication skills.
- Detail orientated, with excellent organizational and planning skills.
- Ability to work independently and with initiative.
- Working knowledge of claim procedures, policies, terminology, etc.
- Demonstrate strong problem-solving and analytical ability.
- Spanish bilingual desirable or other languages.
- Possess a valid driver’s license.
- Ability to travel as necessary.
- Handle files in good faith as defined by statute, case-law and Corporate standards.
- Computer proficient in Word and Excel.
- Sit, stand, walk/ambulatory
- Ability to lift 10 pounds.
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