Claims Examiner - Auto

Auto Casualty Manager

Manager's note: Auto casualty Experienced in complex liability and coverage. TPA experience a plus. Bodily injury/uninsured/underinsured motorist handling experience to include demonstrable(fatality, fractures, traumatic brain injury) injury handling. $ threshold handling up to 1 million. No fault(Personal Injury Protection) experience. Licensed in the contiguous 48 states. Litigation handling experience pertaining to BI/UM/UIM. Not all candidates will need this but a minimum of 3 will need litigation handling experience. Auto Physical Damage handling experience preferred. Experience working in a fast paced environment, participating in and presenting cases to both internal and external stakeholders.

PRIMARY PURPOSE: To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES:

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS:

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

Experience: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.

Skills & Knowledge:

• In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
• Knowledge of medical terminology for claim evaluation and Medicare compliance
• Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
• Strong oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Strong organizational skills
• Strong interpersonal skills
• Good negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

WORK ENVIRONMENT:

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision and talking.

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.