Sr. Environmental Claims Adjuster - Remote Working
Company: North American Risk Services
Posted on: May 6, 2021
SR. ENVIRONMENTAL CLAIMS ADJUSTER - REMOTE WORKING
Claim metrics must be kept current. Handle a caseload up to 150
pending claims that encompass all levels of complexity. Requires
establishing facts of loss, coverage analysis, investigation,
compensability/liability/negligence determination, coordination of
medical care (as appropriate), litigation management, damage
assessment, settlement negotiations, identifying potential fraud
and appropriate use of authorized vendors. Also includes timely and
appropriate reserve analysis and report completion. Ability to
attend conferences, client meetings, mentor other adjusters and
assist management as requested. All file handling must be within
state statutes, Client Claims Handling Guidelines and NARS Best
Practices. Other miscellaneous duties as assigned, which may
Essential Duties and Responsibilities:
-- Identify, analyze, and confirm coverage.
-- Make first contact within parties and client within 8 business
-- Contact appropriate parties and providers to determine
liability, compensability, negligence, and subrogation
-- Contact appropriate parties to obtain any needed information and
explain benefits as appropriate. Continue contact throughout the
life of the file as appropriate.
-- Answer phones, check voice mail regularly, and return calls as
-- Assist with training/mentoring of Claims Adjusters.
-- Assist management when required with projects or leadership as
-- Handle the various duties/responsibilities of the Assistant Unit
Manager/Unit Manager as delegated in their absence.
-- Must be willing and able to attend meetings by Skype or Facetime
-- Refer all files identified with subrogation potential to the
-- Verify facts of loss and pertinent claims facts such as
employment, wages, or damages and establish disability with
treating physicians as appropriate.
-- Identify cases for settlement. Evaluate claims and request
authority no later than 30 days prior to mediation date and
-- Evaluate and negotiate liens.
-- Recognize and report potential fraud cases.
-- Develop and direct a litigation plan with defense attorney (if
assigned), utilizing all defenses and tools to bring the file to
closure. Ensure all filings and state mandated forms are completed
timely. Litigated files must be diaried effectively based on
current activity, but no greater than every 60 days.
-- Review claim files involving active litigation on a monthly
basis at minimum, and document responses to filings, development of
defenses, depositions, and timely referral to defense counsel.
-- Direct the actions of defense counsel on litigated files.
-- Attend mediations and trials as required for cost effective
-- Establish ultimate reserves (anticipated cost to bring file to
close based on known facts) as soon as practical and monitor to
adjust at the time of any exposure changing event.
-- Pay all known benefits, ensuring they are paid timely on state
-- Verify all provider bills have been appropriately reviewed and
paid within standard timeframes.
-- Report all serious injuries/liability issues and potential large
loss claims to the client and/or reinsurer based upon the criteria
provided by the client.
-- Must pass all internal and external audits, which include those
performed by regulatory agencies, carriers, and clients.
-- Follow reporting requests as outlined by client files and NARS
-- Document plan of action in the claim system and set appropriate
-- Maintain a regular diary for monitoring and directing medical
care, case development, or litigation.
-- Close all files as appropriate in a timely and complete
-- Maintain closing ratio as dictated by management team.
Job Requirements: Qualification Requirements:
Education / Licensing:
-- High School Diploma or equivalent required, 2-year degree or
-- 7+ years of prior claim adjusting experience, preferably in the
line of business being handled.
-- Must have 7+ years heavy litigation experience for all other
lines except Worker's Compensation
-- Must have 5+ years Construction Defect or similar/related
experience if handling that line of business.
-- Must be eligible for reserve/payment authority level of $50,000+
-- Must possess, or have the ability to obtain, a Florida
Adjuster's license or other required jurisdictional licensing.
Keywords: North American Risk Services, Atlanta , Sr. Environmental Claims Adjuster - Remote Working, Other , Atlanta, Georgia
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