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Claims Department
Reports To: Claims Director
FLSA Status: Exempt
Job Summary
The Field Adjuster is responsible for investigating claims in the
field that are reported on our policies to determine coverage and
extent of damage in an attempt to reach an appropriate settlement
in accordance with statutory requirements and policy
provisions.
Responsibilities
Essential Duties and Responsibilities include the following. Other
duties may be assigned.
- Confirms coverage and identifies/resolves coverage issues.
Contacts insured same day as claim is assigned.
- Conducts proper investigations and procures supporting reports
utilizing vendors appropriately. Continually evaluates vendor
performance. Identifies and recommends subrogation
opportunities.
- Reviews and processes correspondence and takes appropriate
action. Maintains up-to-date claim file diary.
- Completes assigned claims promptly with full required
documentation. Processes payment and/or denial based on policy
coverage.
- Assesses exposure and sets proper reserves. Notifies management
of large losses in promptly.
- Communicates with customers, agents, and other partners
verbally and in writing in a professional manner. Represent the
company as the technical claim expert for our insureds, agents, and
vendors.
- Maintains appropriate documentation on all claim files and
processes claims in a timely manner.
- Meets company service standards and effectively uses the diary
system to remain current.
- May support special projects, as assigned, within the
established time and quality guidelines.
- Maintains expert claim status through continuing education,
seminars, research, and suit representation. Evaluate defense
counsel and all vendors on a continual basis.
To perform the job successfully, an individual should demonstrate
the following competencies:
Technical Skills - Assesses own strengths and
weaknesses; Pursues training and development opportunities; Strives
to continuously build knowledge and skills; Shares expertise with
others.
Customer Service - Manages difficult or
emotional customer situations; Responds promptly to customer needs;
Solicits customer feedback to improve service; Responds to requests
for service and assistance; Meets commitments.
Interpersonal - Focuses on solving conflict,
not blaming; Maintains confidentiality; Listens to others without
interrupting; Keeps emotions under control; Remains open to others'
ideas and tries new things.
Oral Communication - Speaks clearly and
persuasively in positive or negative situations; listens and gets
clarification; Responds well to questions; Demonstrates group
presentation skills; Participates in meetings.
Written Communication - Writes clearly and
informatively; Edits work for spelling and grammar; Varies writing
style to meet needs; Presents numerical data effectively; Able to
read and interpret written information.
Cost Consciousness - Works within approved
budget; Develops and implements cost saving measures; Contributes
to profits and revenue; Conserves organizational resources.
Dependability - Follows instructions, responds
to management direction; Takes responsibility for own actions;
Keeps commitments; Commits to long hours of work when necessary to
reach goals; Completes tasks on time or notifies appropriate person
with an alternate plan.
Judgment - Displays willingness to make
decisions; Exhibits sound and accurate judgment; Supports and
explains reasoning for decisions; Includes appropriate people in
decision-making process; Makes timely decisions.
Professionalism - Approaches others in a
tactful manner; Reacts well under pressure; Treats others with
respect and consideration regardless of their status or position;
Accepts responsibility for own actions; Follows through on
commitments.
Quantity - Meets productivity standards;
Completes work in timely manner; Strives to increase productivity;
Works quickly.
Safety and Security - Observes safety and
security procedures; Determines appropriate action beyond
guidelines; Reports potentially unsafe conditions; Uses equipment
and materials properly.
Technical & Professional Knowledge - Having
achieved a satisfactory level of technical and professional skills
and knowledge in job-related areas. Keeping abreast of current
developments and trends in area of expertise.
Customer Service Orientation - Implies a desire
to help serve others, to meet their needs. It means focusing one's
efforts on discovering and meeting the needs of the customer (e.g.
agents/brokers, the insured, and other internal customers.
Initiative - A bias for taking action, doing
things proactively and not simply thinking about future actions.
The time frame of this scale moves from completing past or current
projects to acting on future opportunities or problems.
Integrity - internal and external actions are
consistent with what one says is important, that is, he or she
"walks the talk." Communicates intentions and feelings openly and
directly, and welcomes openness and honesty, even in difficult
negotiations with external parties. Demonstrates honesty and
integrity in all dealings.
Quality Orientation & Attention to Detail -
Accomplishing tasks through concern for all areas involved, no
matter how small; showing concern for all aspects of the job;
accurately checking processes and tasks; maintaining watchfulness
over a period of time.
Teamwork - Implies the intention to work
cooperatively with others, to be a part of a team, to work
together, as opposed to working separately or competitively. For
this competency to be effective, the intention should be
genuine.
Resiliency - Maintaining stable performance
under pressure and/or opposition (e.g. time pressure, job
ambiguity). Handling related stress in a manner acceptable to the
person, others, and the organization.
Communication - Expressing ideas clearly in
memos, reports, letters, or other documents with appropriate
organization and structure, correct grammar, and language or
terminology that is tailored to the characteristics and needs of
the audience - internal or external to the organization.
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
functions.
Education/Experience: Bachelor's degree (B. A.)
from four-year College or university; or one to two years related
experience and/or training; or equivalent combination of education
and experience.
Language Ability: Ability to read and interpret
documents such as safety rules, operating and maintenance
instructions, and procedure manuals. Ability to write routine
reports and correspondence. Ability to speak effectively before
groups of customers or employees of organization.
Math Ability: Ability to add, subtract,
multiply, and divide in all units of measure, using whole numbers,
common fractions, and decimals. Ability to compute rate, ratio, and
percent and to draw and interpret bar graphs.
Reasoning Ability: Ability to define problems,
collect data, establish facts, and draw valid conclusions. Ability
to interpret an extensive variety of technical instructions in
mathematical or diagram form and deal with several abstract and
concrete variables.
MS Office Suite and Windows working knowledge. AIIC Claim
System. CERTIFICATES AND LICENSES:
State of Florida 05-20 licensure Must continue education through
AIICPCU/IIA; 1 course per calendar year.
This
job has no supervisory responsibilities.
The work environment characteristics described here are
representative of those an employee encounters while performing the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions.
While performing the duties of this Job, the employee is
regularly exposed to outdoor weather conditions. The employee is
frequently exposed to work in high, precarious places and fumes or
airborne particles. The employee is occasionally exposed to toxic
or caustic chemicals.
The noise level in the work environment is usually moderate.
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions.
The employee must frequently lift and/or move up to 25
pounds.
While performing the duties of this Job, the employee is regularly
required to sit; use hands to finger, handle, or feel; reach with
hands and arms and talk or hear.
The employee is frequently required to stand; walk; climb or
balance and stoop, kneel, crouch, or crawl. |
