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CLAIMS ADJUSTER/REP

Job Description

Do you live near State College Pennsylvania or would you like to relocate to the area? Than this position may be right for you.

Senior Claims Representative- Multi-Line

The Carlisle Group has been Retained to conduct a search for a Senior Claims Representative (Multi Line). Our client is an A rated Mutual Insurance company and they are looking for a Senior Claims Rep to investigate, evaluate, and settle multi-line claims within established authority level, including those of complexity and high exposure.

Essential Functions:

  • Determines coverage and investigates claims:
    • Makes personal, written, or telephone contact with general public, reporting agencies, and suppliers of services/goods.
    • Reviews and interprets policies to determine coverage.
    • Reviews records and documentation.
    • Takes telephone-recorded statements from insureds, claimants, and witnesses involved.
    • Determines liability.
    • Determines amount of loss/damage.
    • Makes assignments to appraisers or independent adjusters as needed.
    • Orders police reports.
    • Indexes injured insured and claimants; follows Medicare reporting requirements and files PLR.
    • Assigns independent adjusters; independent appraisers; and experts to assist in the investigation and evaluation of the claim.
    • Utilizes counsel to assist in coverage and / or investigation of claims.
  • Determines settlement values:
    • Utilizes information gained from claim investigations, applicable regulations, and policy provisions or limits.
  • Reviews reserves:
    • Reviews reserves on a 30-day basis.
    • Modifies as necessary, within established authority, or seeks appropriate approvals.
  • Develops and documents claims files.
  • Establishes and maintains a 30-day diary to updated file handling.
  • Negotiates with insureds, claimants, or legal representatives; settles claims promptly, fairly, and within established authority.
  • Issues claim and expense payments.
  • Secures appropriate approvals for check requisition on claims exceeding authority.
  • Pursues other carriers for subrogation and determines percent of liability (non-auto claims).
  • Handles non-auto salvage
  • Ensures compliance with the Unfair Claim Practices Act and Good Faith Claim Handling regulation.
  • Participates in claim orientation for Underwriting personnel, helping with analysis of coverage and/or claim situations.
  • Performs other miscellaneous duties as assigned or directed.

Qualifications/Basic Job Requirements:

  • Bachelor’s degree or equivalent education and experience combination
  • Proficient interpersonal relations and communications skills (both written and verbal)
  • Thorough knowledge of claims law
  • Proficient analytical and problem solving skills
  • Capacity to work well independently
  • Moderate computer knowledge
  • Demonstrated organizational and time management abilities
  • Demonstrated abilities to deal with a variety of personalities
  • Minimum of five years’ experience with investigation, management, and negotiation of liability and property claims in states of operation

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