Complex Commercial Claims Adjuster - Construction Defect

York Risk Services Group Inc.   •  

Orange, CA

Industry: Accounting, Finance & Insurance

  •  

5 - 7 years

Posted 196 days ago

This job is no longer available.

JOB SUMMARY:

Duties associated with this position include the direct handling of commercial property claims of varying size and complexity for a variety of unique clients, with a focus on continually improving the quality of service.

ESSENTIAL JOB RESPONSIBILITIES:

  • Evaluate losses objectively, set, and maintain proper claim reserves.
  • Make timely initial contact with policyholders.
  • Interpret and evaluate insurance contracts for a variety of carrier clients.
  • Retain and provide oversight for field adjusters, cause and origin experts, building consultants, engineer and other trade experts so claims are properly investigated and adjusted
  • Ensure electronic claim data is properly maintained in a paperless working environment.
  • Establish and maintain adequate claim reserves, including expense budgets.
  • Evaluate claim presentations, verifying for accuracy and compliance with policy provisions.
  • Issue indemnity and expense payments.
  • Prepare and issue timely status letters to policyholders.
  • Prepare written claim reports, which vary by client.
  • Participate in client file reviews to discuss reserve development and claim status.
  • Respond to client audits.
  • Other duties as required to comply with industry specific Best Practices
  • Manage litigation
  • Investigate & evaluate cases
  • Comply with all statutory and regulatory requirements in all applicable jurisdictions.
  • Obtain and review medical records.
  • Interview, telephone, and/or correspond with claimant and witnesses; obtain and review police hospital records, appraisals and repair estimates to evaluate injuries property damage; Report to client as required by contractual account instructions; varying method of investigation according to type of coverage
  • Identify key issues and investigation required.
  • Meet detailed quality assurance standards of performance
  • Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements.
  • Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
  • Revise case reserves based on developments in the course of adjusting the claim
  • Settle claims within assigned levels of authority as set forth in complex, detailed client account instructions
  • Handle complex litigated claims with limited input from the Unit Manager and/or AVP
  • Effectuate prompt payment (with client’s funds) to claimants and service providers
  • Select and manage experts including defense and coverage counsel
  • Work with and provide claim-specific guidance to Field Adjusters
  • Be alert to insurance fraud and implement special procedures if fraud is suspected.
  • Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required

SUPERVISORY RESPONSIBILITIES:

SUPERVISION RECEIVED:

  • This position reports to a Unit Manager within York and directly to our clients on a case-by-case basis if a loss is deemed to be outside of York’s authority.

SUPERVISION EXERCISED:

  • This position manages the work of field adjusters, engineers, forensic accountants and other experts who assist in determining cause of loss, scope of damage, period of restoration and other information as needed to assist the analyst in confirming coverage and processing the claim.

QUALIFICATIONS:

EDUCATION:

  • BS / BA or Equivalent Work Experience
  • State Adjuster licenses as required

EXPERIENCE:

  • Have a minimum five (5) years of inside claims handling experience of first party commercial property losses.
  • Prior experience in assigning and managing assignments to field adjusters and other experts
  • Construction Defect Claim Handling Experience required;
  • CA resident adjusting license required;
  • multiple licensing preferred;

SKILLS/ABILITIES

  • Ability to evaluate losses objectively and set and maintain proper claim reserves.
  • Ability to prepare professional business correspondence to both policyholders and clients
  • Ability to handle large caseloads, particularly following catastrophic events
  • Computer proficient, including the use of Word and Excel programs.
  • Willingness to work in a team atmosphere with direct supervision
  • Possess, or be capable of obtaining, a resident adjusting license.
  • Self-motivated, and open minded with a high initiative and energy level.

KNOWLEDGE:

  • Possess a working knowledge and understanding of residential and commercial insurance policies, including interpretation and evaluation of insurance to value requirements.
  • Computer literate, including the use of Word and Excel programs

ROUTINE DECISIONS AND FORMAL POLICY SETTING:

  • Examples of decisions routinely made
  • Evaluate insurance policies
  • Confirm coverage
  • Contact policyholders
  • Secure claim details upon initial contact, which allows decision to be made if field work is needed.
  • Assign experts
  • Set claim reserves
  • Determine if claim is reportable to our clients
  • Evaluate need for partial payments
  • Decide if subrogation potential warrants referral of claim to recovery or counsel
  • Agree on scope/cost of damages
  • Negotiate claim values with policyholders, public adjusters and/or attorneys
  • Decide when a proof of loss is needed
  • Decide the appropriate time to close a file

R3117