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Total Loss Claims Adjuster I, II, Sr

Company: National General Insurance Company
Location: Winston Salem
Posted on: July 8, 2019

Job Description:

JOB DESCRIPTION

PRIMARY PURPOSE:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. This total loss position can be based in the Cleveland, OH or Winston-Salem, NC office.



ESSENTIAL DUTIES AND RESPONSIBILITIES:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

* Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary

* Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval

* Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option

* Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement

* Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion

* Identify customer needs and work to meet those needs using appropriate customer service skills

* Develop an understanding of the functions of other departments, such as Policy Ops and Marketing



Trainee

* Shadow and learn the above stated essential duties and responsibilities

* Learn to handle most aspects of auto claims

* Develop a basic understanding of the content of policies written by the company

* Develop a basic understanding of the insurance industry and the organizational relationships of the company

* Learn how to determine subrogation or fraud potential and how to handle

* Develop a basic understanding of systems and technology used within the company



Level I

* Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability

* May handle more complex files with appropriate supervision to develop skills

* Develop a working knowledge of systems and technology used within the company



Level II

* Claims involved frequently require analysis and may require research to resolve coverage and/or damage issues

* Periodic review of ongoing activities and results of work

* Focused supervision on complex files; the CRII will handle complex files on a regular basis)

* Receive claim assignments and verifies/investigates coverage and documents all appropriate information

* Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file

* If handling PIP may participate in investigations of medical providers and attend EUOs

* May work with attorneys in resolving lawsuits

* Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level

* Track and document the quality of service provided by defense counsel and manage litigation and recovery costs

* May assist in training of Claims Representatives

* Proficient in using all systems and technology used within the company

* May be required to make personal appearances on behalf of the company when requested



Senior

* Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement

* May inspect damaged property during an investigation

* May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files

* May assist in training and development of other team members or serve as a mentor for others

* May assist with file reviews and audits

* Proficient and able to train others in using all systems and technology used within the company

* May be required to make personal appearances on behalf of the company when requested

* May also assist manager with preparing reports and completing projects



MINIMUM SKILLS AND COMPETENCIES:

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.

National General Holdings Corp. is an Equal Opportunity (EO) employer Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

Keywords: National General Insurance Company, Winston-Salem , Total Loss Claims Adjuster I, II, Sr, Other , Winston Salem, North Carolina

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