Work Comp Medical Only Claims Adjuster

Frankenmuth Insurance Company; Northern (KY); Hybrid; USD 45,000 - 75,000; Full time

Job summary

Frankenmuth Insurance Company is seeking a claims professional who will investigate, evaluate, and resolve general property, casualty and workers' compensation claims under moderate supervision. The role requires eligibility for an adjuster license and experience with general adjuster duties in a regulated environment.

The successful candidate will gather information from agents, insureds, claimants, witnesses, and others; review documents and statements; set reserves within authority; and

Qualifications

• 2–4 years related experience and/or training.
• AA degree or equivalent combination of education and related experience/training.

Responsibilities

• Follows corporate policies, procedures, and fair claims handling practices.
• Investigates claims to determine validity and extent of liability, including: Obtains information to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses and others; Reviews and evaluates documentation, including applications, reports, and statements.
• Monitors appropriate claim outcomes through self-audit process.
• Delivers superior customer service to policyholders and agents, ensuring timely resolution of claims service issues.
• Ensures legal, regulatory and fair claims handling compliance.
• Sets or recommends reserves based on results of claim investigation.
• Within defined authority, manages, evaluates and concludes claims; prepares and maintains claim reports.
• Interacts with insureds, agents, claimants, attorneys, and other service providers; conducts in-depth interviews and/or scene inspections; attends settlement conferences and/or trials.
• May serve on project teams and perform other duties as assigned.

Skills

Adjuster License

Experienced in GA

Education

AA degree or equivalent

Job description

Summary:

Under moderate supervision and following standard procedures with some independent judgment, investigates, evaluates and resolves/disposes of general property, casualty and/or workers compensation claims to determine the extent of company liability; may include determination and evaluation of coverage, compensability, liability and damage in accordance with policy provisions by performing the following duties.

• Adjuster License.
• Experienced in GA.

Essential Duties and Responsibilities:

1. Follows corporate policies, procedures, and fair claims handling practices
2. Investigates claims to determine validity and extent of liability, including:
   1. Obtains information necessary to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses and others
   2. Reviews and evaluates documentation, including applications, reports, and statements
3. Monitors appropriate claim outcomes through self-audit process
4. Delivers superior customer service to policyholders and agents, ensuring appropriate and timely resolution of claims service issues
5. Ensures legal, regulatory and fair claims handling compliance
6. Sets or recommends reserves based on results of claim investigation.
7. Within defined authority, manages, evaluates and concludes claims. Prepares and maintains claim reports.
8. May provide interaction with insureds, agents, claimants, attorneys, and other service providers, including:
   1. Conducts in-depth interviews and/or scene inspections
   2. Attends settlement conferences and/or trials
9. May serve as a member of project teams, contributing to the achievement of project objectives.
10. Performs other duties as assigned.

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/Experience:

Level 4: Two to four years related experience and/or training; or associate's degree (A.A.) from two-year college/technical school; or equivalent combination of education and related experience/training.