The Claims Adjuster will provide technical support and claim services for customers. Will ensure that production and quality control standards set by the company are met on a daily basis. Responsible for monitoring the assigned claim files and ensuring that service standards and quality control standards set by the company are met. Perform all aspects of the job in an accurate and highly motivated fashion.
· Investigate, manage and resolve claims of all values, including complex liability/injury
· Manage and direct all aspects of insurance claims litigation
· Must possess a thorough understanding of all products and services. Understand the impact/relationship these products have on the team and technological support system. As such, must be able to provide technical expertise relative to system, legal and compliance issues as they arise.
· Negotiate the settlement of claims with clients
· A thorough understanding of managed care products and services, and understand the impact such products have on claim administration and individual claim filing handling. Able to effectively interface with service vendors, claimants, and providers to successfully resolve open issues and bring resolution to the claim file.
· The goal is to maintain the minimum monthly corporate standard average pending file count.
· Monitor workload closely and take appropriate measures to ensure claim files are closed within parameters set by the company.
· Utilize the technology available to effectively support their workload and eliminate manual processing of claim administration.
· Assist with the identification and correction of problems and errors. Provide ideas and suggestions, which increase the quality of products.
· Provide excellent telephone services to claimants, clients, contacts, and outside vendors. On an ongoing basis, improve service knowledge and recognize the importance of providing superior customer service to our customers.
· Ensure that all inquiries are responded to in a timely manner. Demonstrate good written and oral communication skills
· Determine need for independent adjusters, cause and origin experts, independent medical examiners, economists, accident reconstructionist, and engineers
· Evaluate claim for potential fraud and report to the appropriate authorities
Required Knowledge, Skills, and Abilities
· Must make independent claims handling decisions on claims assigned
· Hard work, honesty, integrity and unwavering business ethics
· Detail-oriented organization skills in a multi-tasking environment
· Success driven individual who has demonstrated success in a claims adjusting role
· Capable of setting and making decisions on reserve levels
· Consistent attention to detail and data resolution
· Communicate effectively and professionally in writing, by telephone, or in person.
· Strong proficiency in keyboarding and data entry skills
· Must be able to foster and maintain positive internal and external customer service relationships
· Bachelor’s degree required
· 1-2 years Liability Claim handling experience preferred
· Obtains and maintains NC adjuster’s license and complies with continuing education requirements.
· Must also be able to interpret state and federal law in addition to contracts and policies.
Delivering value, safety, and total peace of mind every day is not just our business, it’s our purpose.
Join our team.
Dedicated. Innovative. Driven. Successful.
AAA Carolinas - 15 months ago
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