Job Description

Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals, and settles claims utilizing claims best practices. Evaluates and sets reserves using independent judgment. Assists the supervisor and company attorneys in preparing cases for litigation. Conducts training and mentors new hires.

Responsibilities

• Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
• Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.
• Analyzes claims activity and prepares reports for clients/carriers and management.
• Establish reserves, using independent judgment and expertise, and authorize payments within the scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements.
• Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
• Develops subrogation and third-party recovery potential and follows reclaim procedures.
• Analyzes claims activities and prepares reports for clients, carriers, and/or management. Participates in claim reviews.

Qualifications

• Bachelor's degree or equivalent experience required. Industry designations preferred but not required (IIA, AIC, AEI, and/or CPCU).
• Technical claims investigations/settling experience with 4-8 years of experience in Claims or a similar organization.
• Ability to work independently while assimilating various technical subjects.
• Strong written and oral communication, negotiation, and presentation skills.
• Advanced analytical and problem-solving skills, with the ability to manage and prioritize multiple projects.
• Effective advanced interpersonal skills to interact effectively with all levels of internal and external clients.
• Workers' Compensation (WC) Adjuster License required according to jurisdictional requirements

Desired experience:

• History using Independent Medical examinations (IMEs) and Medical Record Reviews (RRs) to effectively manage the Longshore claims 
• An understanding of Longshore and Harbor Workers’ Compensation Act (LHWCA) rules pertaining to IMEs and RRs, including but not limited to:
• Reasonable notice and distance to the exam date
• Travel Expenses
• No Show consequences
• Experience managing Longshore and Defense Base Act claims in multiple jurisdictions, including but not limited to CA, FL, LA, and TX.
• Technical Longshore claims investigations/settling experience with 5-8 years of experience in Longshore Claims or a similar organization.