The Claims Complex Casualty Adjuster handles complex claims involving material damage, property, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of complex claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under limited supervision, works within specific limits of authority to resolve claims.
Job DutiesConduct phone and/or field investigations to determine liability and damages. Identify and obtain statements from insureds, claimants and witnesses. May attend and participate in legal proceedings.
Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing which complies with regulatory and statutory requirements. Recognize and appropriately address complex coverage and subrogation issues.
Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
Negotiate within settlement authority with insureds and claimants to resolve their first and third-party claims.
Control expenses for areas of responsibility.
Handle administrative functions, update database production reports, document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
Mentor other adjusters, assisting them with increasing understanding of adjudicating complex claims.
Respond quickly to customer needs and problems.
Independently resolve claim exposures within level of authority.
Qualifications
Bachelors Equivalent combination of education and experience Preferred
7-9 years Property, Auto, Casualty or relevant claims experience. Required
10+ years Prior claims experience. Preferred
Comprehensive knowledge of claims administration best practices and procedures.
Advanced knowledge of insurance, fault assessment, negligence and subrogation principles.
Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
Advanced knowledge of Microsoft Office suite, general computer software and claims software.
Advanced organization and planning recognition skills required.
Advanced oral and written communication skills required.
Advanced interpersonal skills required.
Advanced leadership skills among peers required.
Exhibit proficiency and understanding of medical terminology and causality.
Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
Associate in Claims - Insurance Institute of America Preferred
An insurance/claims adjuster license may be required for claims administration in specific states. Preferred
The starting pay range for this position is:
$42.41 - $56.55Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.
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Remarkable benefits:
• Health coverage for medical, dental, vision
• 401(K) saving plan with company match AND Pension
• Tuition assistance
• PTO for community volunteer programs
• Wellness program
• Employee discounts
“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
AAA is an Equal Opportunity Employer
The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).
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