Claims Adjuster II (Property, Auto, & Liability)

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Remote

About The Position

Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority. Logistics: Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This is a full-time position, with a Remote schedule, working an 8-hr. shift (40-hours/week) Monday-Friday 7:30am – 5:00pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. Due to initial training period and some on-site activities, qualified, local candidates need apply.

Requirements

Bachelor's degree (see degree equivalency below)
4 years job related work experience or Associate's and 2 years job related work experience.
2 years of area related adjusting experience).
Valid adjustor's license in required states or ability to acquire within 6 months-if required by the resident state's department of insurance.
Analyzes laws, regulations and contract language.
Evaluates issues and develops recommendations.
Handles confidential and sensitive information.
Investigates assigned claims.
Proposes claims adjustments and refunds.
Works claims caseloads.

Nice To Haves

Strong organizational skills.
Solid ability and experience navigating multiple systems.
Able to work independently.
Able to manage distractions effectively.
Strong communication skills, both verbally and written.

Responsibilities

Conduct investigations of assigned claims (workers comp, first and third-party property, general liability or auto physical damage) in adherence with corporate timeliness and quality performance standards. investigations include contacts with injured, physician and/or employer.
Exercise independent judgment in evaluating/determining the extent and nature of investigative efforts based on the complexity of each claim.
Document activities, case action plans, settlements evaluations and requests for authorizations in the claim notes.
Provide management and internal and external customers with documentation to support recommendations and claim status as required.
Direct the litigation process and work with attorneys to establish defense strategy and case legal budget. negotiate settlements with opposing counsel. May require attendance or testimony at hearings, trials, or mediations.
Evaluate specials, damages, and/or extent of disability, and negotiates settlement with individual claimants and/or attorneys.
Utilize independent adjustors to assist in the evaluation of liability and for damages and reports findings.
Review independent adjustor's reports and handle claim outcomes.