Casualty Claims Adjuster II
About The Position
This position is eligible to work from home anywhere in the United States. Step into a role where your expertise directly drives meaningful outcomes, leveraging your investigative instincts, sound judgment, and negotiation skills to bring clarity and resolution to complex claims. In this position, you will make an immediate impact by confidently guiding claims from first notice through resolution, balancing thorough investigation with efficient, fair settlements. Your ability to interpret coverage, evaluate liability, and manage litigation will not only protect the organization but also deliver exceptional experiences to insureds and claimants. By collaborating cross-functionally and acting as a trusted partner to agents, vendors, and internal teams, you will play a critical role in reducing risk, controlling costs, and strengthening relationships while continuously elevating the quality and integrity of the claims process.
Requirements
- Bachelor’s degree or equivalent relevant experience
- Three years of casualty claims adjusting experience or related experience
- Relevant insurance designations preferred
- Strong knowledge of the theory and practice of the claim function
- Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws
- Strong knowledge of computers and claims systems
- Ability to obtain all applicable state licenses
- Ability to adhere to high standards of professional conduct and code of ethics
- Good organizational and empathetic interpersonal skills
- Strong written and verbal communication skills
- Strong investigative and problem-solving abilities
- Excellent customer service skills
- Ability to maintain confidentiality
- Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling
Nice To Haves
- Relevant insurance designations preferred
Responsibilities
- Investigates and evaluates moderately complex auto and casualty claims, confirming coverage, deductibles, and payees against policies and regulations
- Initiates timely contact with insureds, claimants, and witnesses to explain the process and gather statements
- Collects, reviews, and documents investigative reports, claim forms, and supporting materials in the claims system
- Maintains accurate claim documentation, including activity logs, report summaries, and reserve analysis (including Medicare/MSP)
- Establishes and adjusts timely, appropriate reserves in line with company methodology
- Identifies and pursues subrogation and recovery opportunities, ensuring proper evidence handling and compliance
- Ensures adherence to state regulatory requirements, including timely issuance of required communications and forms
- Manages low-complexity litigated files, including recommending and coordinating defense counsel assignments
- Oversees and evaluates vendors, invoices, and expenses for accuracy, appropriateness, and cost-effectiveness
- Drafts coverage determinations, including reservation of rights and denial letters with appropriate approvals
- Provides clear, timely status updates to agents, insureds, and claimants and escalates issues as needed
- Evaluates liability and damages, prepares negotiation strategies, resolves liens (including Medicare), and negotiates settlements
- Finalizes settlements, including documentation, releases, payments, and participation in mediations or arbitrations
- Collaborates cross-functionally (SIU, Subrogation, Legal, Underwriting, Risk) while contributing to team support, training, and projects
Benefits
- Comprehensive rewards package
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
