No Fault/PIP Claims Adjuster II - Temporary
At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.
The role of the Casualty Claims Adjuster (CCA) is to investigate, evaluate and resolve general liability, automobile liability and automobile physical damage claims under commercial policies, memoranda of coverage, as well as for self-insured private and public entities. The Casualty Claims Adjuster is assigned claims generally consisting of low- to medium- exposure, first and third party automobile bodily injury and property damage claims, as well as premises liability accidents, product liability and public entity tort claims.
ESSENTIAL JOB RESPONSIBILITIES:
- Evaluate coverage based on an investigation that includes, but is not limited to, the claim report, the insurance policy, memorandum of coverage and applicable statutes and case law to determine if a claim can be accepted as being within coverage. Determine coverage aspects and prepare coverage letters as necessary.
- Evaluate compliance with the applicable governmental statutes, including tort claims statute with in-depth knowledge of multi-jurisdictional claims handling issues.
- Identify and report to client key coverage, damages, and liability issues; develop plan and conduct investigation utilizing appropriate methods according to type of coverage and nature of the exposure. Investigation shall be in accordance with contractual obligations and prevailing professional standards along with York quality standards.
- Interview, by telephone or in-person, and/or correspond with claimant and witnesses, including taking recorded or written statements; obtaining and reviewing police and other official reports, hospital records, appraisals and repair estimates to evaluate injuries and property damage.
- Report to client as determined by contractual account instructions and consistent with company policy and guidelines.
- Obtain, evaluate medical records to make a causation and/or damage assessment.
- Maintain current all licenses, continuing education requirements and certifications.
- Calculate the extent of the clients financial exposure with respect to claims, including but not limited to, liability, estimated expenses and potential indemnification; analyze information to set case reserves for use by clients and applicable regulatory authorities.
- Revise case reserves based on diverse factors, including additional evidentiary and medical developments in the course of adjusting the claims.
- Have a sense of awareness to fraud factors and implement Special Investigation procedures if insurance fraud factors are detected.
- Negotiate and settle claims within assigned levels of authority as set forth in client account instructions and consistent with company policies and guidelines.
- Use analysis of situation to recommend appropriate experts for testimony regarding damages and liability or, when not to use said experts.
- Involve client in decision-making as set forth in client account instructions and consistent with company policies and guidelines. Determine when to involve the client in decision-making by applying clients instructions and corporate guidelines.
- Collaborate with co-workers on analysis of situations.
- Manage caseload by developing and executing an appropriate plan of action for each file, including setting appropriate diaries.
- Be available for after-hours calls from clients for immediate analysis and response to accident scenes or loss locations to conduct appropriate investigation and /or claim management.
- May plan the work of support staff members and determine if/when vendors is needed.
- BS / BA or Equivalent Work Experience
- Licenses as required
- Experience applying principles of investigation management including, but not limited to, immediate situational evaluation; case value analysis preliminary and ongoing; application of investigative tools, such as taking appropriate witness statements while evaluating credibility; determining coverage and application of coverage to claims; litigation management; client management; negotiation and resolution of claims.
- Minimum of 3 years of industry experience, with the ability to be trained to learn all aspects of casualty claims handling; prior casualty claims handling experience a plus.
- Oral and written communication and presentation skills
- Analytical and interpretive skills
- Organizational skills; ability to multi-task; Capable of setting and managing priorities
- Solid interpersonal skills; customer service skills; negotiation skills
- Work well under pressure
- Spanish fluency is a plus
- Proficient in Microsoft Office Suite.
- Normal business office environment. Sitting for long periods of time, while operating a telephone and personal computer
- Reaching, keyboarding, grasping, kneeling, talking, hearing, seeing, repetitive motions, exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move.
- During field work, driving a vehicle up to 2 hours each way and exposed to outdoor weather conditions
The intent of this job description is to describe the major duties and responsibilities performed by incumbents of this job. Incumbents may be required to perform job-related tasks other than those specifically presented in this description.
All duties and responsibilities are essential job functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.