Must have Florida 520/620 license. This is with a P&C carrier out of Florida.
The Senior Commercial Claim Adjuster will handle a caseload which encompasses all levels of complexity for first-party claims, including establishing facts of loss, conducting proper reserve and coverage analysis, assessing and estimating property damage, assigning experts as needed, identifying potential fraud and… timely investigate claim for proper resolution. The Senior Commercial Claim Adjuster will also serve as a mentor to junior adjusters and assist with training, as needed.
Knowledge of insurance regulations claims practices and statutory requirements, governing case law, ADR methodology, DFS mediation and disputed claims resolution is required.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
• Verify facts of loss and pertinent information to analyze and confirm coverage.
• Establish ultimate reserves (anticipated cost to bring file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Explain and appropriately respond to insured’s, public adjusters, attorney’s and contractors during telephone contacts; as well as, contact the appropriate parties to obtain any needed information, provide timely investigation status updates, explain settlements and/or ultimate claim disposition.
• Timely submit reserve and payment approval requests, as appropriate.
• Identify claims requiring a Reservation of Rights and refer for management approval.
• Formulate and execute appropriate ADR strategy in compliance with statutory guidelines.
• Apply advanced negotiation skills to effectuate resolution of disputed claims with insureds or their legal representative.
• Coordinate appraisal process, maintain communication necessary to ensure appraisal process is moving forward in timely fashion.
• Draft denial letters for management approval.
• Identify and refer claims with subrogation potential to the subrogation department.
• Identify and refer cases with potential NICB fraud indicators.
• Virtually investigate and resolve claims, as appropriate, with the use of video technology.
• Serve as mentor and/or trainer, as needed, to junior adjusters.
• Strictly adhere to Best Practices and operational guidelines, as well as all statutory requirements.
• Interfaces with company clients, carrier, adjusters, or covered parties. Communicates with agents regarding status of claim.
• Completes and/or reviews, approves, or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
• Resolves disputes regarding claims resolution. Responsible for reopening and re-evaluating claim, as necessary.
• Participates in litigation when applicable.
EDUCATION and/or EXPERIENCE
• Bachelor’s degree
• A minimum of 10 years of Commercial claims experience preferred.
• In-depth professional knowledge of all aspects of claims operations.
• Florida 520/620 license is required.
• Ability to obtain AL, GA, NC and SC adjusters licenses.
• Strong commercial coverage interpretation and claims handling background is required.
• Must have commercial construction knowledge and be proficient in Xactimate.
CERTIFICATES, LICENSES, REGISTRATIONS
• Florida 520/620 license is required.
• Ability to obtain AL, GA, NC and SC adjusters licenses