Claims Adjuster

Claims Adjuster Job Summary:
Under general supervision, investigates, analyzes, and determines the extent of the company's liability involving accidents, incidents, or other occurrences involving the property, vehicles, or employees resulting in third-party personal injury or property damage. Interviews medical specialists, agents, witnesses, or claimants to obtain the facts of the incident; assembles all necessary evidence, including interviews, reports, site investigations, photographs, and all drawings prior to deciding on the claim. Negotiates and prepares claims settlements and determines liability based on valuation of injuries, medical reports, bills, estimates, and related facts. Denies claims when investigation reveals they are unsubstantiated. Processes liability and subrogation claims utilizing an electronic claim administration system. Documents the electronic file with claim activity and processes payments to vendors and claimants. Working conditions are primarily inside an office environment. Exercises no supervision.

Claims Adjuster Responsibilities:

• Investigates allegations of negligence made by third parties who have suffered a tort to determine legal liability
• Collects documentation to determine the extent of damages to facilitate settlement of compensable claims
• Prepares documentation memorializing claim activity in a Risk Management Information System and articulating liability analysis
• Communicates with involved parties based on investigation and liability position
• Establishes appropriate reserve levels based on financial exposure and provides appropriate documentation to explain any change in the reserve upon receipt of new information
• Negotiates claim settlements based upon a determination of the company's liability and evaluation of the damages through review of medical reports, medical bills, statement of values, estimates, or other documentation provided to support a proof of loss
• Prepares settlement memorandum to seek settlement authority and provides such documentation and direction to Claims Assistant to properly pay settlements and invoices
• Annotates, categorizes, and addresses incoming claims correspondence including medical records and statement of values
• Assists Attorneys with the handling of litigated claims including active participation in mediation and settlement negotiations
• Pursues subrogation of property damages or enforcement and collection of the workers' compensation lien incurred due to the compensable injury of an employee as a result of the negligence of a third party
• Performs related duties and fulfills responsibilities as required.

Claims Adjuster Knowledge & Experience:

• Knowledge of insurance coverage and concepts including coverage for property, workers' compensation, casualty, automobile, and other insurable risk
• Knowledge of insurance principles and concepts
• Knowledge of general negligence principles and governmental immunity, in particular the Texas Tort Claims Act
• Knowledge of public entity claims handling on multiple lines of business
• Skilled in working with various Risk Management Information Systems to document claim activity and maintenance of claim diary system
• Ability to operate a computer keyboard and other basic office equipment
• Ability to represent the company through strong and effective negotiations, while maintaining the company's high customer service standards
• Ability to analyze a proof of loss and/or property appraisal to determine actual cash value owed to claimants
• Skill in utilizing personal computers and associated MS Windows- based software applications (e.g. Word, Excel) and federal/state designed programs in the completion of assignments
• Ability to maintain confidential information and work independently and with a team
• Ability to maintain and submit accurate records within the required time periods
• Ability to communicate clearly and effectively
• Ability to estimate time and materials needed for projects
• Ability to perform all the physical requirements of the position

Schedule:

• Monday – Friday
• 7:45 am – 4:30 pm

Equal Employment Opportunity (EEO), Affirmative Action, and E-Verify Statement:

Integrated Human Capital is an equal opportunity employer committed to fostering diversity and providing employment opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, age, disability, or any other protected status. We actively promote affirmative action by encouraging minorities, women, individuals with disabilities, and veterans to apply for positions for which they are qualified. Additionally, Integrated Human Capital participates in the E-Verify program to verify the identity and employment eligibility of all newly hired employees, ensuring compliance with immigration laws. Candidates are required to present documents confirming their identity and eligibility to work in the United States during the employment verification process.

#NSA