Claims Adjuster II – Complex Litigation
Presbyterian Healthcare Services
Salary
💰 $100,000 - $136,000 per year
Job Level
Senior
About the role
- Our Claims team is currently looking for a Senior Claim Consultant to join us in NJ or PA. While this is a remote position, qualified candidates must reside in one of these states to best serve our policyholders.\n
- Investigates, evaluates, and disposes of MPL and General Liability claims with varying degrees of complexity and severity.\n
- Interview insureds, claimants, witnesses, and other appropriate parties to obtain information used to assess liability exposure.\n
- Document file regarding results of investigation and negotiations.\n
- Prepare reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action.\n
- Secure records for investigation and evaluation of cases.\n
- Determine and implement negotiation strategy and negotiates settlements within authority level.\n
- Adjust reserves within level of authority and make reserve recommendations to Manager/Director for amounts over position authority level.\n
- Evaluate cases for appropriate disposition and seek authority for settlement from manager/director when settlement amount requests exceed authority.\n
- Direct and monitor activities of defense counsel in compliance with Case Management Guidelines.\n
- Monitor trials and attend pre-trial proceedings, mediations, and arbitrations as necessary.\n
- Identify significant insured Risk Management or Underwriting issues and direct the information to appropriate department.\n
- Communicate with insureds, claimants, and witnesses; consult medical and other relevant records, varying methods of investigation according to type of claim.\n
- Analyze losses to determine if insurance coverage applies.\n
- Maintain working knowledge of policy forms and can confirm policy in effect for date of loss.\n
- Performs other duties as assigned.
Requirements
- Bachelor's degree from four-year college or university.\n
- R.N. or J.D. preferred with 5 years’ experience in clinical nursing and/or 5 years claims experience dealing with serious bodily injury.\n
- Insurance adjuster's license may be required for specific states.\n
- Knowledge of medical, legal and insurance terminology is required.\n
- Must hold a current driver's license.\n
- Strong written and oral communication skills.\n
- Must be comfortable making oral presentations to staff and insureds.\n
- Must have training in contract/policy review and application.\n
- Ability to read, analyze, and interpret insurance policy coverage forms, professional journals, technical procedures, or government regulations.\n
- Ability to write reports, business correspondence, and technical case summaries.\n
- Ability to effectively present information and respond to questions from groups of managers, insured's, agents and attorneys.\n
- Must be able to synthesize complex or diverse information; collect and research data; use intuition and experience to complement data; design workflows and procedures.\n
- Must have the ability to design and generate creative solutions.\n
- Experience with Microsoft Word, Excel, PowerPoint.\n
- Able to work with minimal supervision on a day-to-day basis.\n
- Ability to travel 20-25% required.
