Claims Adjuster

Claims Adjuster Summary : The primary responsibility of this position is to analyze complex or technically difficult general liability and workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. The adjuster is responsible for the prompt and efficient examination, investigation, settlement , or declination of commercial insurance claims through effective research, negotiation, and interaction with insurers and claimants, ensuring that company resources are utilized in a cost-effective manner in the process . This may include negotiating property, injury, workers' compensation, and subrogation claims and managing the City's relationships with third-party administrators, independent adjusters, legal counsel, various experts, and suppliers. The position will be assigned specific objectives , including reporting, resolving claims, and returning injured employees to work as quickly as possible, maximizing financial recovery, and proactively minimizing financial exposure . The position has responsibility in all areas of claims management. Essential Functions : Essential duties and responsibilities may include, but are not limited to, the following : Analyze, review, and interpret policies to assess coverage and liability. Negotiates settlement of claims within designated authority. Determine and facilitate or perform the necessary level of investigation on complicated claims to bring a claim to an equitable conclusion for all parties involved. Properly document information in the claim file and drafts coverage letters, including reservation of rights and denial letters. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Investigate each claim by verifying and reviewing damages to determine the root cause. Identify fraudulent claims and lead investigations. Determine the applicability of coverage and liability. Ensures timely and cost-effective claims resolution. Identifies emerging exposure and leads safety training initiatives. Participate in contract renewals and budgeting. Inspect property damage and physical injuries. Interview witnesses to understand the nature of the claim and understand any relevant preceding events. Consult with outside experts such as engineers, physicians, and lawyers. Analyze complex information from different sources . Examine police reports, video footage, audio, and other pertinent information to understand the incident further. Prepare and process the claim report detailing the events and damage related to the claim []{style="padding: 0px; font-size: 12pt; font-family: tahoma, arial, helvetica, sans-serif; line-h "}