Under the supervision of the Claims Manager, the Claims Adjuster is responsible for investigating, analyzing, and determining the extent of the company's liability for property and casualty claims involving loss or damage. The role involves gathering relevant information through correspondence or interviews with company staff, claimants, witnesses, and other involved parties. The Claims Adjuster will establish financial reserves, manage litigation and mediation processes, facilitate settlements, and document all activity in the company's electronic claims database. Performance will be evaluated based on client satisfaction, adherence to company and industry best practices, and the ability to close claims in a timely and cost-effective manner. A high degree of independence and initiative is expected.
Essential Duties and Responsibilities:
Claims Investigation:
Investigate property and liability claims or incidents reported by company members and assigned by the Claims Manager.
Conduct inquiries through direct communication with member staff via phone, email, or in-person contact, depending on the nature and severity of the claim.
Gather evidence and relevant information by interviewing witnesses and knowledgeable parties, inspecting property, reviewing documents, and analyzing reports.
Assess the extent of property damage and prepare detailed investigative findings.
Claims Evaluation and Administration:
Review claims and related documentation to confirm coverage under the company's Memorandum of Coverage.
Analyze investigative findings to determine liability and recommend appropriate actions.
Assist members with claim decisions in accordance with the Governmental Claims Act.
Evaluate subrogation opportunities and develop strategies for effective and efficient claims resolution.
Establish, monitor, and maintain expense and indemnity reserves within authorized limits.
Approve payments related to claim expenses and settlements.
Proactively pursue claim resolutions before litigation when possible and seek necessary settlement authority.
Participate in regular claim review meetings and provide input on complex matters.
Direct and coordinate activities with defense counsel for litigated claims.
Attend mediations, settlement conferences, and trials as required.
Compile and organize evidence for litigation support.
Electronic File Management:
Input all claim data into the company's claims management system in accordance with established procedures.
Maintain detailed file notes, correspondence, and activity records to support claims handling efforts.
Use diary systems to ensure timely and efficient claim management.
Regularly update reserves based on current information and claim developments.
Other Responsibilities:
Perform additional related duties as assigned.
Essential duties and reporting structure may be modified at the discretion of the CEO.
Qualifications and Skills:
Education and Experience:
High school diploma or GED required; Associate's or Bachelor's degree from an accredited institution preferred.
Minimum of 10 years' experience in claims administration, specifically in property and/or liability claims.
Strong background in litigation management and subrogation.
In-depth knowledge of relevant state and federal laws, case law, and regulations, particularly as they relate to governmental entities and risk management.
California claims adjusting license preferred, but not required.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county , to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.
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