Claims Litigation Representative

SUMMARY:

Investigate coverage, liability and damages for heavy bodily injury claims, property damage, and other various legal actions brought against our insured's as well as the company. Manage 150 or more litigation files to final resolution through focused negotiations and/ or by assisting defense counsel in developing appropriate action plans and strategies for defense up to and including trial. May participate in mediations, depositions and attend trials. Maintain loss and expense reserves according to case facts as they are developed and track key litigation information through the suit register.

ESSENTIAL RESPONSIBILITIES:

• Analyze policies, claims forms, all documentation obtained and any other evidence to verify available coverage, assess liability and determine appropriate compensation, if any, based on damages and proof presented.
• Review all claims activity prior to lawsuit and conduct any additional investigation necessary to assess coverage, liability and damages. This may include additional interviews with any involved parties, witnesses, agents or others.
• Determine the need for defense counsel versus settlement attempts on the front end with timely initial review and handing within 24 hours of receipt and a detailed 'to-do' list for subsequent activity. Seek settlement opportunities at each stage of litigation and focus claims management on those activities necessary to overcome any obstacles to resolution.
• Maintain communication with the insured and defense counsel throughout the handling of a lawsuit, keeping the insured informed from suit acknowledgment through closure. Ensure counsel adherence to company guidelines for defense and manage the process with current action plans and follow through as well as cost management.
• Keep an accurate account of all case activity through proper documentation and recording of all information as it becomes available.
• Accurate and detailed preparation of case reports for management review to include serious injury reports, case status reports, pre-trial reports and others upon request.
• Stay current and in compliance with all company policies and procedures in addition to state regulations and statutes applicable to those cases in your inventory.
• Obtain or maintain appropriate licensing in those states where adjuster licenses are required
   

KEY QUALIFICATIONS:

• Bachelor's degree preferred, or equivalent work experience.
• AIC, SCLA and CPCU designations a plus.
• At least 3 years adjusting experience with Direct, or 5 years outside adjuster experience.
• Knowledge of laws and regulations pertaining to auto claims processing and fair claims practices.
• Strong skills in the areas of verbal and written communication with an ability to develop and maintain positive customer, co-worker, management and third party relationships.
• Experience and ability to handle an environment demanding extreme time management, case management, prioritization, documentation and accountability.
• Experience in an automated claims processing work environment.
• Knowledge of fraud reduction practices.
• Proven strong analytical and critical thinking skills.
• Experience with, and solid knowledge of medical and legal terminology with an ability to read and interpret medical reports as well as legal pleadings.
• Experience working with defense attorneys and plaintiff attorneys and the ability to utilize powers of persuasion to help lead to reasonable claims resolutions in the best interest of the insured and/or the company.