Job Description

As a dedicated Injury Examiner, you will be responsible to adjust complex bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy. This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Chesapeake, VA or Tampa, FL. Relocation assistance is not available for this position. Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. Serves as a resource for team members on complex claims. Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours. May be assigned CAT deployment travel with minimal notice during designated CATs. Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. Requirements include High School Diploma or General Equivalency Diploma, 4 years auto claims and injury adjusting experience, advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations, advanced negotiation, investigation, communication, and conflict resolution skills, strong time-management and decision-making skills, investigatory, prioritizing, multi-tasking, and problem-solving skills, advanced knowledge of human anatomy and medical terminology associated with bodily injury claims, ability to exercise sound financial judgment and discretion in handling insurance claims, advanced knowledge of coverage evaluation, loss assessment, and loss reserving, and acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. Preferred qualifications include 2 or more years of catastrophic injury experience, experience handling UM/UIM injury claims, college degree (Bachelor’s or higher), and insurance designation.

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