Sr Claims Adjuster

1 week ago

Fort Wayne, United States Brotherhood Mutual Full time

Job Title: Sr Claims Adjuster

FLSA Status: Exempt

Job Family: Claims

Department: Claims

Location: In-Office (Fort Wayne, IN)

JOB SUMMARY

Responsible for effectively analyzing and resolving assigned serious/complex claims consistent with claims department standards and company objectives.

POSITION ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

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.

  • Resolve primarily serious/complex, (including but not limited to claims involving unusual damage or coverage issues or need to involve expert analysis or that require early recognition of policyholder concerns), claims within established settlement authority in a prompt, fair and equitable manner. Identify and investigate coverage, damage, and reserve adequacy on assigned claims.
  • Apply statutes, common law, and other applicable legal and regulatory concepts for the effective, efficient and equitable resolution of assigned claims.
  • Achieves established claim file audit objectives.
  • Communicate with policyholders, agents, claimants, attorneys, medical providers and other persons as needed and direct independent adjusters, appraisers and other support service providers to ensure effective, efficient, and equitable claims resolution.
  • Acquire, record and maintain all essential file documentation in accordance with established guidelines.
  • Provide timely status reports regarding assigned claims to department management and others.
  • Identify and pursue appropriate cost containment, loss mitigation and subrogation recovery opportunities.
  • Participate and provide input in departmental meetings or interdepartmental meetings, projects or processes that relate to the claims function.
  • Travel as needed to attend training programs, conferences, mediations/other legal proceedings, and to conduct investigation relating to claims resolution.
  • Further the attainment of overall department objectives by assisting other claims personnel as needed.
  • Participate as needed in the orientation or training of new department personnel.
  • Assist in the setting of initial reserves as needed.
  • Complete other projects as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Must be able to effectively communicate with others (both oral and written). Must be able to communicate complex coverage and legal concepts in both an oral and written format.
  • Must be able to make independent decisions.
  • Must have strong organizational and interpersonal skills.
  • Must have the ability to handle confrontational situations in a productive manner. Must possess strong negotiation skills and utilize them in the resolution of serious/complex claims.
  • Must have a thorough understanding of all issues related to claims. Must have a thorough understanding of coverage.
  • Must be able to access, input and retrieve information from a computer. Must have a thorough understanding of all automated claims department processing systems and workflows.
  • Must be able to train others on claims department policies, procedures and systems.
  • Should be able to sit for prolonged periods of time. Should have the ability to inspect losses by walking, lifting, climbing or bending.
  • Effectively interface with external contacts, Brotherhood employees, managers, and department staff members.
EDUCATION AND/OR EXPERIENCE
  • Bachelor's degree required.
  • Must be able to take and pass mandatory adjuster licensing requirements.
  • Must have five or more years of claim technical experience.
  • CPCU designation strongly desired.
  • Seven years or more of Brotherhood Mutual claims technical experience is desired.


Terms and Conditions

This description is intended to describe the general content of and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Because the company's niche is the church and related ministries market, and because effective service requires a thorough understanding of this market, persons in this position must be familiar with church operations and must conduct themselves in a manner that will neither alienate nor offend persons within this target niche.

Brotherhood Mutual Insurance Company reserves the right to modify, interpret, or apply this position description in any way the company desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. This position description is not an employment contract, implied or otherwise. The employment relationship remains "at-will".

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