Job Title: Casualty Claim Adjuster
Job ID: 03462
Division : Claims Operations
Work Location(s): United States-Arizona-Phoenix
Full/Part Time: Full-Time
- Depending on qualification, person(s) selected may qualify for higher level position.
- A 45-60 minute online assessment will be administered to candidates selected to interview for this position.
- Number of positions posted is subject to change based on the quality of applicants.
The Casualty Claim Adjuster primarily handles non-injury casualty claims of minor to moderate complexity that may include, but are not limited to, comparative fault, coverage investigation, and auto thefts. May handle claims that involve medical payments and/or Personal Injury Protection (PIP). Continues to build a mastery of skills and insurance knowledge required of this position. Supports the division goal of ensuring industry-leading customer service and works with business partners to deliver seamless claim service.
- Securing Factual Evidence and Investigation (40%)
- Recognizes and interprets primarily Auto, Homeowner, Specialty and Recreational policies.
- Reviews loss report and any prior action taken on the file to determine next steps.
- Recognizes the need for and obtains non-waiver as needed. Recognizes the need for and sends reservation of rights letters.
- Secures, preserves, and maintains all evidence necessary (official reports, photographs, measurements, etc.) to complete a thorough claim investigation and determine the proper course of action.
- Secure statements and communicates with all parties as needed to obtain information in order to determine proximate cause of loss.
- Identifies, investigates, and evaluates subrogation and contribution opportunities.
- Consults with appropriate personnel on more complex issues.
- Analyzing and Evaluating Factual Evidence (15%)
- Analyzes and evaluates factual information to formulate an opinion on liability claim losses that do not involve bodily injury, including loss of use and related expenses. Escalates cases that involve injury and/or current or prior medical history/problems.
- Identifies state-specific differences in policies and contract coverages and applies to all parties for assigned losses. Reviews state-specific legislation and legal precedent based on prior legal cases for assigned geographic area and seeks assistance as needed.
- Interprets claim history coverages. Selects proper loss codes based on policy type. Recognizes economical, legal, and practical consequences of decisions.
- Utilizes company claim bulletins, manuals and best practices. Demonstrates knowledge of underwriting guidelines, evaluates risks and makes recommendations to the Underwriting Department as needed.
- Recognizes potentially fraudulent claims, utilizes SIU and other sources as needed, and consults with management.
- File Management (15%)
- Manages individual claim inventory and collaborates with peers to achieve unit and branch results.
- Utilizes the electronic integrated claim system and other technologies to complete and document actions throughout the life of the file.
- Contributes to the team environment by assisting with claims from other adjusters' inventories in their absence.
- Works with customers, responds to inquiries, makes appropriate decisions, and closes file as appropriate.
- Negotiation, Settlement (15%)
- Negotiates and settles claims in accordance with divisional expectations.
- Handles claim negotiations by providing a clear explanation of the coverage and/or liability decision to the customer, answering all questions and processing the claim payment.
- Recognizes, controls and resolves disputes. Utilizes arbitration, appraisal and alternate dispute resolution as needed.
- Reviews available data to determine extent of coverage or non-coverage and communicates results to appropriate parties.
- Business Partner Relationships (5%)
- Establishes rapport with business partners (agency, personal lines, legal, etc.) and builds ongoing relationships by including stakeholders in the claim handling process as appropriate.
- Partners with others to provide seamless customer service.
- Facilitates communication between customers, agents, vendors, third party administrators and other employees. Provides agents with important claim related information; provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
- Explains and discusses any circumstances that may affect customer service with agency, vendors, third party administrators or other claim personnel. Includes others in problem resolution as appropriate.
Specialized Knowledge and Skills Requirements
- Achieve Results
- Be Accountable
- Maximize Customer Experience
- Concern for Quality
- Conflict Resolution
- Information Gathering
- Planning & Organizing
- Technical Expertise
- Basic knowledge and understanding of policies and endorsements related to casualty coverage.
- Basic knowledge and understanding of each phase of the casualty claim handling process.
- Demonstrated experience handling casualty claims of minor complexity (e.g., clear liability, basic coverage questions).
- Must be willing to travel for Catastrophe duty if necessary.
- This position requires travel up to 10% of the time
- Offer to selected candidate(s) will be made contingent on the results of background checks.
- A career move to join American Family Insurance may also mean a physical move for you. If selected for an interview, information will be provided on the level of relocation assistance.
Please review the job requirements.
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