Senior Injury Adjuster – UM

Role Overview

• Adjusts attorney-involved soft tissue and moderately complex claims with injuries (e.g., torn meniscus, broken bones, disc herniations) and UM/UIM claims, as well as some auto physical damage associated with those claims
• Identifies, confirms, and makes coverage decisions on soft tissue and moderately complex bodily injury claims
• Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes
• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates
• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation
• Partners with and/or directs vendors and internal business partners to facilitate timely claims resolution
• Delivers a best-in-class member service experience by setting appropriate expectations and proactive communication
• Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours
• May be assigned CAT deployment travel with minimal notice during designated CATs
• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures

Requirements

• High School Diploma or General Equivalency Diploma
• 2 years of auto claims adjusting experience
• 1 year of injury adjusting experience with attorney represented claims
• Proficient knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations
• Proficient negotiation, investigation, communication, and conflict resolution skills
• Demonstrated time-management and decision-making skills
• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills
• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims
• Ability to exercise sound financial judgment and discretion in handling insurance claims
• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving
• Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts

Benefits

• comprehensive medical, dental and vision plans
• 401(k)
• pension
• life insurance
• parental benefits
• adoption assistance
• paid time off program with paid holidays plus 16 paid volunteer hours
• various wellness programs
• career path planning and continuing education