Job Summary
This is a multi-state position which requires proficiency in interpreting, understanding and applying multiple policies/products and multi-jurisdictional claim handling requirements. The individual will need to possess or be able to obtain the appropriate state adjuster licenses required by state statute. The individual in this position will handle a pending of automobile casualty losses which will consist of primarily No-Fault and Med Pay features, with some exposure to low severity Bodily Injury and Un/Under Insured Motorist claims.  With appropriate training, there may be some exposure to litigation management and/or arbitration.  This individual will be responsible for screening new losses to determine coverage exposures, thoroughly investigating liability and injuries and assuring timely and effective processing and medical cost management of No-Fault and Med Pay claims.  In addition, this individual may have exposure to Bodily Injury claim investigation, evaluation and negotiation, through disposition, of low severity Bodily Injury claims.  Frequent oral and written communication with medical providers, customers and attorneys are required and these communications must be timely and professional.  Strong telephone customer service skills and the ability to empathize with claimants and customers are needed.  Individuals should possess a high level of initiative and demonstrate the ability to work both independently and in a team environment with high productivity expectations in a fast paced environment.  Strong business and decision making skills, as well as the ability to maintain a high degree of confidentiality are required.  A moderate degree of independence is expected. The current opening is primarily the handling / adjusting of New York PIP No-Fault Claims.

Knowledge, Skills and Abilities
Education: Bachelor's Degree or professional level of knowledge in a specialized field, or equivalent, related experience.
Experience: 4 - 6 years - or Associates Degree equivalent plus 6 - 8 years.

Knowledge: General knowledge of industry practices, standards, and concepts within field of work. Applies them to perform work requiring analytical business skills.
Decision Making: Makes decisions related to a wide variety of situations within management limits. Interprets guidelines and procedures, applying judgment and discretion. Decisions influence portions of a project, client relationships and/or expenditures.
Supervision Received: Works independently under general supervision. Work is reviewed for overall adequacy in meeting objectives.
Leadership: May provide training and guidance to less experienced staff.
Problem Solving /Operations/Direct Work Involvement: Develops solutions to a variety of problems, typically of moderate scope and complexity. Refers to and interprets policies and practices for guidance.
Client Contacts: Contacts other departments and or external organizations or parties frequently. Contacts are primarily at or below upper management levels. Represents organization on specific projects. Communication may involve persuasion, and negotiation.

Additional Knowledge, Skills and Abilities
A minimum of four years claims adjusting experience and college degree or equivalent work experience
required. This position requires proficiency in interpreting personal auto policies. This individual would possess exceptional customer service skills, strong negotiating skills and the ability to organize and prioritize work to assure customer service and productivity goals are met. Insurance Industry education strongly preferred. Strong telephone customer service skills and the ability to empathize are needed. General skills should include basic PC skills, specifically, accurate keyboarding skills. Individuals should possess a high level of initiative with the ability to work in a team environment with high daily workloads. Strong business and other decision making skills, as well as a high degree of confidentiality is required. Individuals will work independently with minimal supervision. Bilingual skills a plus. May be required to obtain necessary licensing for geographic area based upon business needs.
Completion of the Casualty Claim Training program may be required. Familiarity with the NY Medical Fee schedules and NY Workers Compensation experience a plus.

Essential Duties and Responsibilities
CUSTOMER SERVICE

1.        Understand and comply with all customer service standards and practice the Ten Corporate Caring Values. Timely recognition and completion of mandated deadlines.

2.        Practice empathy and professionalism in all dealings with customers, recognize individual situations and promptly respond to their needs.

3.        Conduct thorough and prompt investigations of the accidents/losses and make timely liability determinations and settlements.

4.        Assure that oral and written communications with customers are timely, clear, concise and empathetic.

5.        Demonstrate your commitment to teamwork and take initiative to assist others.

6.        Be proficient in the use of Claims Operational Systems, including the AS-400, lotus notes, and desktop property software.

7.        Assure that voice mail is properly utilized and telephone messages are promptly returned.

QUALITY AND PRODUCTIVITY

1.        Adjust assigned losses utilizing an authorization level of $10,000 to $20,000+.

2.        Perform necessary investigation to make an accurate determination as to liability and identify contributors/codefendants. Utilize appropriate investigative techniques to include:

a.        Recorded/written statements

b.        Locus investigation/site analysis/diagrams

c.        Accident reconstruction/collision analysis

d.        Witness canvas.Dram shop investigations

e.        Research and apply relevant jurisdictional statutes and case decisions

3.        Perform damage analysis and investigation consistent with procedural expectations to include fifteen month file reporting on claims not evaluated and Claim File Analysis on claims with reserves in excess of $50,000. Proactively develop damage information on liability claim exposures and initiate investigation of those damages that may be excessive, contrived or unrelated.

4.        Employ the use of experts as necessary, to assist in the analysis of alleged damages.

5.        Investigate and verify wage loss allegations using appropriate investigative techniques.

6.        Proactively determine the appropriate time to prepare an evaluation and extend a settlement offer.

7.        Prepare written evaluations and LCD statements describing/analyzing coverage, liability, each aspect of the claimant’s damages, mitigating factors, the impact of the injury on the claimant’s life, as well as, a strategy to conclude the claim.

8.        Draft various technical documents and correspondence including: Reservation of Rights and Disclaimer letters, responses to Insurance Department complaints, responses to Demand letters; Claim File Analysis; and other correspondence as is necessary.

9.        Achieve settlement of claims through telephone negotiations, face-to-face settlement conferences, or other medium as necessary.

10.     Adhere to established practices of claim file handling, as well as in existing state laws and regulations governing the processing of insurance claims.

11.     Achieve unit productivity goals to include: Identifying and creating the appropriate claims, meeting open / closed claim expectations, and maintaining a current diary.

TECHNICAL KNOWLEDGE

1.        Maintain proficiency in the use of the Personal Auto policy, as well as, relevant state statutes and case decisions which impact the adjustment of Automobile claims.

2.        Perform coverage analysis and investigations on assigned claims; determine coverage exposures and the applicability of policy endorsements, limitations and exclusions.

3.        Perform independent research, as necessary, to understand the relationship and significance of injuries suffered.

4.        Understand and comply with the corporations reserving philosophy by initiating timely and appropriate reserve adjustments.

5.        Demonstrate the ability to identify potentially fraudulent claims, and initiate the investigation necessary to determine whether SIU consultation is warranted.

6.        Manage assigned claims in litigation by conferring with and directing defense counsel on discovery activities, assuring that instructions and reporting requirements are adhered to and that settlement is pursued when desirable.

7.        Complete timely and thorough CFA’s on applicable claims for examining review.

LEADERSHIP/ROLE MODELING

1.        Serve as a peer trainer to less experienced adjusters and assist in their professional development.

2.        Represent the company through participation in legal proceedings or other similar forums.

3.        Initiate improvements in workflows, operating systems and the delivery of claims service and participate on committees and work-teams as needed.

4.        Aways strive to exhibit positive behavior and professionalism in all business dealings.

5.        Demonstrate accountability/dependability through commitment to company standards, procedures and expectations.

6.        Always strive to enhance occupational competencies through professional development activities.

MISCELLANEOUS

1.        The individual must possess, or be able to obtain, the appropriate state adjusters license as required by statute.

Adheres to Company policies and procedures as outlined in the Human Resources Policy Guide.

Follows departmental and functional area standards, rules, guidelines, processes and policies as identified by management.

Secondary Duties and Responsibilities

Physical Components

1.        Manual dexterity to operate various pieces of office equipment efficiently.

2.        Ability to stand and/or sit for extended periods of time.

3.        Ability to lift light objects.

4.        Ability to effectively communicate on the telephone and in person.

Additional Requirements

Disclaimer Statement
The statements made in the job description are intended to describe the general nature and level of work being performed by people assigned to this job. These statements are not intended to be an exhaustive list of all responsibilities, duties and skills required of the people assigned to this job.