Claims Adjuster Job Description
Claims Adjuster Duties & Responsibilities
To write an effective claims adjuster job description, begin by listing detailed duties, responsibilities and expectations. We have included claims adjuster job description templates that you can modify and use.
Sample responsibilities for this position include:
Claims Adjuster Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Claims Adjuster
List any licenses or certifications required by the position: AIC, CPCU, ASE, ARM, ANFI
Education for Claims Adjuster
Typically a job would require a certain level of education.
Employers hiring for the claims adjuster job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Associates, Management, Technical, The College, Business/Administration, Communication, Public Administration, Legal
Skills for Claims Adjuster
Desired skills for claims adjuster include:
Desired experience for claims adjuster includes:
Claims Adjuster Examples
Claims Adjuster Job Description
- The candidate must have excellent interpersonal skills and strong verbal and written communication skills
- Knowledge of claims database systems is preferred
- Takes recorded statements from claimants, insureds, witnesses, and prepares summaries
- Conducts investigations into minor single and multi-car accidents to obtain additional claims and coverage information and assist in determining liability
- Reviews investigation notes and determines claim value, coverage and liability for basic claims
- Properly screens self-pay patients for a variety of third-party payer programs according to the guidelines of the reimbursement programs
- Updates and completes proper forms and documentation according to Company procedure for the coding, closing and suspending of accounts
- Assist patients with the appropriate paperwork and ensure timely filing of the MVA claims
- Maintains progress on all suspended accounts
- Prepared lien documents and submits to county entity via electronic recording process or coordination with on-site staff
- ACII qualified or progress towards completion of insurance qualifications is preferred or legally qualified
- Good communication, investigation and analytical skills
- Experience of ECF repository and CLASS is preferred
- Ability to work under own initiative with minimum supervision part of a team
- Ability to perform basic math calculations (addition, subtraction, multiplication, and division) the calculation of averages and percentages
- Associates Degree in Business field or equivalent experience preferred
Claims Adjuster Job Description
- High School equivalency, bachelor’s degree in a related discipline is preferred
- Interview with claimant and witnesses gather information police and hospital records, estimates to determine injuries
- This position reports to the Unit Manager
- Claims handling experience and working knowledge of auto and mortgage Lender placed or Force placed Insurance preferred
- Develop and maintain knowledge to moderate level of medical terminology and demonstrate translation in to layman terms on a day to day basis
- Evaluate medical claims that suspend within the Medical Claims System utilizing EmblemHealth’s PPO proprietary conventional coding structure
- Utilizing Claims Operation’s C-More Adjudication Guidelines portal, reference QA memorandums, training guidelines, departmental memos, PRG’s, and apply business rules to claims as instructed for adjudication
- As necessary, manually price claims utilizing the appropriate rate files while considering the provider’s network and the beneficiary’s insurance policy
- As needed, access PPO’s PC Helper applications such as CWI-Viewer Application, Anesthesia Calculator, PC History Look-Up and any other helper application developed by GHI to support claims processing
- Perform any projects delegated by claims supervisor
- Knowledge of auto insurance
- Healthcare knowledge a plus (but not required)
- Automotive Technical Abilities / hands on Technician experience
- Automobile Servicing / Repair Experience
- Self-motivated team player with good communication skills (verbal and written)
- Excellent decision making, negotiation and conflict resolution skills
Claims Adjuster Job Description
- Perform a variety of tasks under the direction of management to investigate, evaluate, claims according to the company standards, the Nevada Innkeepers Statute and applicable insurance coverage
- The position will have no settlement authority but will train to understand settlement rational
- Responsible for answering phones, routing calls and providing general information to guests
- Prepares written correspondence, file, fax, photocopy and process incoming and outgoing mail
- Assist the Claims Representatives with support as needed
- Support the management of the department as needed
- Weekend “on-call” responsibility once the employee has satisfactorily learn the department procedure as support for the primary on-call Claims Representative
- Take responsibility for handling various accounts within the Casualty claims team
- COLLABORATE.Be part of a team dedicated to AAA members and one another
- Analyze and process claims, correspondence and status inquiries from both providers and members
- Previous automotive / technical experience at either a manufacturer or dealer level is required, especially in the Parts and Service area
- Working knowledge of Microsoft Office Suite and other PC applications
- ASE Automobile & Light Truck Certified Preferred
- Excellent computer skills including are needed due to multiple claim systems and automated recovery tools such as ISO, Arbitration Forums
- Ability to carry out detailed written or verbal instructions
- Ability to perform 80 percent sedentary work, exerting up to 10 pounds of force occasionally and negligible force frequently or constantly to move objects, including the human body
Claims Adjuster Job Description
- Ensure the resolution of claim issues routed for clarification
- Denies, settles, or authorizes payments to a wide range of property/casualty claims based on coverage, appraisal, and verifiable damage
- Corresponds with policyholders, claimants, witnesses, attorneys, to gather important information to support contested claims in court
- Resolves complex claims- such as BI, FIRE, LIT
- Acts as lead when needed for back up or absent Lead
- Handles claims following our client’s best practices and standard work which may include, but is not limited to, underinsured motorist, fatalities, and mediation/litigation management
- May handle claims that involve medical payments and/or Personal Injury Protection (PIP)
- Provide industry-leading customer service and works with business partners to deliver seamless claim service
- Evaluates and settles bodily injury and property damage claims
- Help guide customers, over the phone, through the claims process by investigating how their auto accident occurred and ensuring that their claims experience is a smooth as possible
- Administers claims of numerous ancillary products that are financed when a customer purchases a vehicle
- College degree is not a prerequisite for this position
- Resident license required
- Multiple state licenses preferred
- Bachelor’s degree in related field from four-year college or university preferred
- Licensed in multiple jurisdictions
Claims Adjuster Job Description
- Comfortable with manipulating data and producing reports
- As an Inside Liability Determination Adjuster, you will play a vital role to ensure we deliver on our promise to help restore people’s lives after they experience a loss
- You will analyze police reports and interview parties involved in accidents via the phone, to evaluate the cause of the accident, who’s at fault, and to what degree
- Research and respond to moderately complex and occasionally complex customer communications, concerns, conflicts or issues
- Summarize and document a claim file with notes, evaluations and decision making process
- Provide overview of coverage limits in moderately complex and occasionally complex claims
- Take recorded statements from involved participants, witnesses, medical providers, , conduct investigations into moderately complex and occasionally complex auto accidents, determine liability, and prepare summaries
- Negotiate and settle claims in accordance with business unit best practices and determined claim value
- The candidate should be handle associated claims under CLH (Charterer’s Liability to Hull)
- Provide timely response to and/or the closure of the claim, with fair treatment and adequately reflecting actual liability
- Ability to organise workload, under pressure, whilst meeting tight deadlines
- On-call = None
- TBD Adjuster's licenses must be secured within 60 days of employment
- Required to obtain an adjuster license in some states once hired
- Training will be 6 weeks M-F 8-5 – 100% attendance required
- This position will be filled in Troy, NY