Insurance Benefits Claims Processor Jobs in Decatur, TX

PURPOSE OF POSITION

The Bodily Injury Pre-Litigation Adjuster is responsible for prompt review of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds and claimants. This Adjuster is often assigned to review and resolve complex bodily injury claims before a lawsuit is filed. The Bodily Injury Pre-Litigation Adjuster maintains a solid understanding of the company mission, vision, and values, and upholds the standards of the Company.

Pre-litigation adjusters are responsible for investigating coverage and liability as well as evaluating insurance claims on behalf of insurance companies. They investigate the circumstances of insurance claims by consulting with witnesses, reviewing police reports, and compiling evidence from other sources. They will negotiate claim settlements and ensure a prompt and satisfactory settlement for claimants while avoiding the costs and complexities of the litigation process.

RESPONSIBILITIES

• Interprets and determines policy coverages under personal and commercial lines.
• Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimant, witnesses and producers.
• Gathering and evaluate evidence, including medical bills and injury and reports
• Verifies coverage and policy conditions. Reviewed coverage issues as needed with supervisor. Typically utilized standardized language to draft positions if needed.
• Depending on the type of claim may interact internally or externally to gather information.
• Establishes reserves by estimating the most likely outcome of a claim. Evaluates the facts of each exposure using evidence, experience, and company procedures. Adjusts reserves timely as additional evidence is received.
• Effectively negotiates, and settles, high priority claims and bring claims to a timely and satisfactory resolution before a lawsuit can be filed.
• Builds critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret, and understand key or root issues.
• Establishes and maintains effective relationships with customers and gains their respect and trust.
• Demonstrates ability to absorb technical information and learns from mistakes in order to achieve best possible outcomes for claimant, customer and company.
• Writes in a clear, succinct, and fact-based manner in Claims files as well as in other written communication.
• Manages time and diary entries effectively and efficiently, prioritizing work in a fast-paced environment.
• Performs other functional duties as required.

Candidates Must Have:

• Decisive and purposeful.
• Handle a caseload/pending that may include levels of complexity.
• Solid understanding of civil litigation procedures and legal terminology.
• Capability to evaluate complex medical damages and expert testimony.
• Great strategic decision-making and risk assessment skills.
• The ability to manage time, meet deadlines and prioritize tasks effectively.
• Ability to successfully manage a high-volume case load.
• Ability to effectively negotiate; and use stated adjuster authority responsibly.
• Ability to simplify, analyze and explain complex coverage and legal issues.
• Ability to be able to review processes and determine opportunities for improvement.
• Strong moral character and work ethic.
• Independent and self-starting.
• Strong verbal and written communication skills.
• Ability to thrive in a “fast pace,” challenging environment.
• Ability to show initiative, exhibit a “can do” attitude, and provide ideas while working within a team environment.

Education / Licensing / Experience:

• Bachelor's degree/or equivalent work experience (with high school diploma).
• Commercial Bodily Injury Claims Handling Experience or 4-years related claim experience required.
• Must possess, or can obtain, an Adjuster’s license or other required jurisdictional licensing as needed.

Technical Skills:

• Requires ability to negotiate claims.
• Must have interpersonal skills to handle sensitive and confidential situations and information.
• Requires ability to work independently.
• Requires excellent organization and time management skills.
• Must be detailed oriented.
• Must be able to maintain a high level of accuracy.
• Ability to work with highly confidential information.
• Highly organized and excellent time management skills required.
• Excellent oral, written and interpersonal communication skills.
• Effective and efficient use of computer applications including MS Office products.

The above statements are intended to describe the general nature and level of work being performed by the incumbents of this job. They are not intended to be an exhaustive list of all responsibilities and activities required of this position