To address and handle high end cases with serious injuries, complex coverage scenarios and legal inquiries or disputes;
to develop a strategy to bring a case to satisfactory resolution.
Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.
Handles high end cases with serious injuries and/or complex coverage scenarios.
Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.
Identifies cases for settlements/redemptions.
Gathers/documents additional information and coordinates with client designees.
Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.
Responds to plaintiff's counsel, union, employee, or client requests.
Identifies issues and formulates defense strategy.
Establishes/adjusts accrued liability and approves administrative expenses.
Identifies subrogation opportunities and manages process.
Attends and participates in mediations, trials, arbitrations or hearings as needed.
Works with partners to affect early return-to-work.
Performs other duties as assigned.
Supports the organization's quality program(s).
Requirements
Bachelor's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
Secure and maintain the State adjusting licenses as required for the position.
Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.
technically skilled and familiar with legal pleadings, discovery, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, analytical and interpretive skills, strong organizational skill, excellent negotiation skills, ability to work in a team environment, and ability to meet or exceed Performance Competencies.