Complex Property Claims Adjuster

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Summary

The Complex Claims Adjuster will adjust losses involving multifaceted elements of assigned claims. Strong investigate skills are required, in order to make a coverage determination and subsequent damage evaluation, once coverage is accepted. The ability to promptly analyze and prepare action plans and present to the claim manager, based on multiple data sources is required. Knowledge of Florida insurance regulation claims practices and statutory requirements, governing Florida case law, ADR methodology, inclusive of appraisal, DFS mediation and disputed claims resolution is required. The Complex Claims Adjuster will also serve as a mentor to less experienced adjusters and assist with training, as needed. The ability to work extended hours, including evenings and weekends, based on customer and business needs, as well as in response to catastrophic weather, is required. A competitive candidate will have a high level of technical competence, attend training, assist management with other duties and work collaboratively with co-workers.

Job Description, Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Verify facts of loss and pertinent information to analyze and confirm coverage.
• Handle the adjusting of the entire claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make coverage recommendation and issue payments within applicable authority level.
• Contact insured(s) to schedule inspection of damaged property in a timely manner.
• Keep insured(s) informed on all steps of the claim investigation and progress to resolution.
• Determine the method and extent of investigation for each claim. Make assignment to outside experts or investigators when appropriate.
• Review and analyze all investigative and claim material to determine the facts of the loss, in a timely manner.
• Document all claim actions, inclusive of coverage and damage investigations, contacts, phone calls, emails, and correspondences in the claim file.
• Check e-mails and messages daily. Respond to all calls, emails, and questions in a timely manner.
• Establish ultimate reserves (anticipated cost to bring file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Explain and appropriately respond to insureds, public adjusters, attorneys, contractors, and any additional involved parties to obtain needed information, complete a timely investigation, relay status updates, explain settlements and/or ultimate claim disposition.
• Timely submit reserve and payment approval requests, as appropriate.
• Identify claims requiring a Reservation of Rights or denial, draft appropriate coverage correspondence and refer for management approval.
• Identify claims best suited to be be resolved through DFS Mediation and/or appraisal and timely demand appropriate ADR option.
• Attend mediations, as assigned, and apply technical knowledge to facilitate claim resolution negotiations.
• Apply advanced negotiation skills to effectuate direct resolution of disputed claims with insureds or their legal representative.
• Coordinate appraisal process, maintaining communication necessary to ensure appraisal process is timely moving forward toward binding award.
  
  

QUALIFICATIONS:

• Attention to detail.
• Ability to multi-task.
• Solid written and verbal communication skills.
• Effective oral, written, organizational and analytical skills required.
• Strong computer skills and the ability to work effectively under stress.
• Interpersonal skills to develop relationship with insured’s, PA’s, opposing counsel, defense counsel, vendors, and contractors to enhance the appropriate flow of information.
• Maintain Florida 520 License. Obtain Alabama, North Carolina, South Carolina, and Georgia, if applicant does not currently possess same.
• Minimum 5 years’ experience and/or training in P & C Insurance or equivalent combination of education and experience.
• Ability to regularly use computer and certain software programs. Strong computer and data entry skills required.
  
  

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE:

A four-year college degree is preferred along with prior insurance experience with an insurance carrier or agency. Minimum 5 years’ experience and/or training in P & C Insurance or equivalent combination of education and experience.