Job Title: Senior Case Manager/Senior Claims Representative- CS
Department: Claims- RMSC
Reports to: Executive Director- Claims
FLSA Status: Exempt
Job Code: CS11SCME
Summary Manages and evaluates liability claims for clients.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Investigates claims for merit and legitimacy by gathering documentation from all affected parties, identifies and verifies damage to person or property either through statements or on-site investigations or meetings with clients. Establishes appropriate pricing of claims based on research and analysis.
Notifies clients of results of investigations. Discusses lines of authority for specific claims resolution. Makes recommendations for settlements or denial of claims. Processes denials.
Manages complex or multi-jurisdictional claims.
Negotiates claims with claimants and or claimants’ legal counsel. Obtains required releases for finalization of claims. Maintains post-litigation files.
Properly reserves funds. Adjusts client claim reserves appropriately.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
High school diploma, bachelors degree strongly preferred and a minimum of five years related experience and/or training; or equivalent combination of education and experience.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Certifications or licenses
Valid Adjuster’s license.
To perform this job successfully, an individual should have knowledge of Agency management systems; Database software; Internet software; Spreadsheet software and Word Processing software.