Claims Adjuster

Triple-S Management Corp.; Northern (KY); Hybrid; USD 55,000 - 85,000; Full time

Job summary

Triple-S Management Corp. is seeking an experienced Insurance Claims Adjuster to analyze, investigate, and process client-submitted claims. This role involves planning within the department, anticipating customer needs, and ensuring timely, accurate claim resolution.

The position requires a Bachelor's degree and relevant licensure, with 1–5 years of adjuster experience or equivalent claims work. You will interact with claimants, witnesses, and professionals to determine coverage and payments.

Qualifications

• Bachelor's degree required for consideration.
• 1–5 years of claims adjusting experience or related tasks.
• Licensed adjuster in the applicable line of business.
• Strong analytical and negotiation skills.

Responsibilities

• Investigate and process insurance claims submitted by policyholders.
• Interview claimants and witnesses to gather information.
• Assess damages and determine compensation based on policy.
• Collaborate with SIU and Subrogation to identify fraud.
• Prepare weekly reports and communicate with clients by phone or written communications.

Education

Bachelor's Degree

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Let's build healthier communities together, join now!

JOB SUMMARY

Responsible for analyzing, investigating and processing any paperwork that the client presents that is related to their claim. Conduct planning efforts within your department, whether for operational or day-to-day situations. Anticipates customer needs and acts proactively to achieve customer satisfaction.

ESSENTIAL FUNCTIONS

• Investigate and process insurance claims submitted by policyholders.
• Interview the claimant and witnesses to gather pertinent information.
• Properly inspect the damage to determine the extent of the loss. Assess the damages to determine the amount of compensation. Analyze that coverage is applicable through an insurance policy and prepare adjustments.
• Consult police and hospital records among other required documents. Consult with accountants, architects, construction workers, engineers, lawyers and doctors for an expert evaluation. Examine photographs and record statements.
• Evaluate all information to determine how the claim should be handled.
• Negotiate with the claimant and, or attorney to resolve the claim; issue payment amount for settled claims.
• Open, close and adjust reserves in accordance with company practices designed to ensure reserve adequacy.
• Submit serious incident reports, reinsurance reports and other information to claims management as required.
• Collaborate with SIU and Subrogation to identify fraud and subrogation opportunities.
• Preparation of weekly reports, as required.
• Serve clients in person or by telephone. Issue written communications to the parties.

EDUCATION

• Bachelor's Degree

EXPERIENCE

• Bachelor’s degree with one year of experience as Adjuster. Or instead, Associate Degree (60 to 64 college credits) with at least 2 to 3 years of experience as an Adjuster. Or 3 to 5 years of experience in tasks related to Insurance claims (Casualty, Property or Automobile Claims).
• Insurance Commissioner’s Adjuster License (depends on line of business assigned).

LICENSES AND CERTIFICATIONS

COMPETENCIES

• Manages Ambiguity
• Action Oriented

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Veterans and Disabled to Apply.