Claims Adjuster

Summary

:

The primary responsibility of this

position is to analyze complex or technically difficult general liability and workers compensation claims to

determine

benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to

identify

subrogation of claims and negotiate settlements. The adjuster

is responsible for

the prompt and efficient examination, investigation, settlement

, or declination of commercial insurance claims through effective research, negotiation, and interaction with insurers

and claimants, ensuring that company resources are

utilized

in a cost-effective manner in the process

.

This may include negotiating property, injury, workers' compensation,

and subrogation claims

and

managing the City's relationships with third-party administrators, independent adjusters, legal counsel, various experts, and suppliers. The position will be assigned specific

objectives

, including reporting, resolving claims, and returning injured employees to work as quickly as possible, maximizing financial recovery, and proactively minimizing financial exposure

.

The position

has responsibility in all

areas of claims management.

Essential Functions

:

Essential duties and responsibilities may include, but are not limited to, the following

:

Analyze, review, and interpret policies to assess coverage and liability.

Negotiates settlement of claims within designated authority.

Determine

and

facilitate

or perform the necessary level of investigation on complicated claims to bring a claim to

an equitable

conclusion for all parties involved.

Properly document information in the claim file and drafts coverage letters, including reservation of rights and denial letters.

Calculates and assigns

timely

and

appropriate reserves

to claims; manages reserve adequacy throughout the life of the claim.

Investigate each claim by verifying and reviewing damages to

determine

the root cause.

Identify

fraudulent claims and lead investigations.

Determine

the applicability of coverage and liability.

Ensures

timely

and

cost-effective

claims resolution.

Identifies

emerging exposure and

leads

safety training initiatives.

Participate in contract renewals and budgeting.

Inspect property damage and physical injuries.

Interview witnesses to understand the nature of the claim and understand any relevant preceding events.

Consult with outside experts such as engineers, physicians, and lawyers.

Analyze complex information from

different sources

.

Examine police reports, video footage, audio, and other pertinent information to understand the incident further.

Prepare and process the claim report detailing the events and damage related to the claim

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