claim adjuster

Comprehensive Risk Services, LLC

This is a remote position, but the adjuster must live in Michigan. Comprehensive Risk Services LLC (CRS) provides superior claims and risk management services for self-insured employers and self-insured groups. CRS is a privately owned Michigan based company with a single focus on employee and client satisfaction. If you are dedicated and ambitious, Comprehensive Risk Services is an excellent place to grow your career.This is a great opportunity for skilled Workers&rsquo; Compensation Adjusters with an established ability to investigate, adjust and settle claims.The selected candidate will be responsible for adjudicating workers&rsquo; compensation claims for designated clients including litigated, lost time, and serious medical-only claims.Essential duties include but are not limited to:&middot; Maintain responsibility for assigned accounts to ensure prompt investigation, evaluation, and disposition of all claims&middot; Manage claims on an ongoing basis to confirm timely direction with written communication to all involved parties&middot; Oversee claims handling procedures to ensure established company and client standards are met&middot; Attend hearings as required and act as a work comp liaison between client and defense attorneys&middot; Initiate and facilitate settlement negotiations directly with claimants&middot; Investigate and follow up on third party cases and ensure client lien and recovery rights are protected&middot; Establish and monitor reserves in accordance with company standards&middot; Schedule independent medical evaluations and activity investigations&middot; Monitor loss runs and generate excess carrier reports&middot; Prepare claim reports and complete special projects&middot; Attend claim review meetings and provide in-service for new and current clients&middot; Develop/maintain successful relationships with external vendor partners while managing expected resultsQualifications:&middot; 5+ years of experience as a Workers&rsquo; Compensation Claim Adjuster&middot; MS Office experience (Word, Excel, Outlook)&middot; Strong verbal and written communication skills&middot; Ability to prioritize workload to meet deadlines&middot; College degree or equivalent work experience is requiredJob Type: Full-timePay: From $60,000.00 per yearBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>Do you have workers&rsquo; compensation claim adjuster experience?</li></ul>Location:<ul><li>Michigan (Required)</li></ul>Work Location: Remote

Workers’ Compensation Claim Adjuster

Educational Service District 112

<div></div><div><div><div>Thank you for your interest in our employment opportunities. We invite you to apply to be a part of our dynamic team providing quality educational services throughout Southwest Washington, and other areas of the state. For more information review the NEOGOV Application Guide and Frequently Asked Questions.
</div>
</div><div><div><h2 class="jobSectionHeader">General Responsibilities</h2></div>
<div>Under the general direction of the Senior Claims Administrator and the Risk Management and Member Services Manager, the claims adjuster supports investigation, evaluation, and resolution of property and casualty claims for the SW Washington Risk Management and Insurance Cooperative and provides support and assistance with risk management and member services activities. 
Salary: 
The full range for this position is $32.89-$40.02 per hour. Offers are made at the beginning of the range. 
 
Assignment: 
This position is year round and will work a minimum of 20 hrs/week with potential of up to 40 hrs/week. 
A complete application will include:<ul><li>
Work history going back 10 years (if applicable)</li><li>
At least three professional reference's contact information</li><li>
A Cover Letter expressing interest in the position</li><li>
A Resume that reflects work experience listed on application</li><li>
Proof of your degree.</li></ul><div>
This position is open until filled with applications received by 5:00 p.m. on Wednesday, April 20, 2026 receiving first consideration.</div></div> 

<div><h2 class="jobSectionHeader">Essential Functions/Other Functions</h2></div>
<div>Essential Functions:<ul><li>
 Assist in the intake, review, and processing of new property and casualty claims, including maintain accurate and timely claim file documentation in claims management systems, determining appropriate reserves and tracking claims.</li><li>
Coordinate inspections, appraisals and repairs for property losses.</li><li>
Support claim investigations by gathering facts, statements, reports, photos and documentation.</li><li>
Communicate with claimants, vendors, internal staff, and school district personnel in a timely and professional manner. Prepare correspondence, reports, and claims summaries.</li><li>
Help evaluate coverage, liability and damages under the supervision of the Assistant Superintendent or Sr Claims Administrator and consult with Risk Co-Op member districts regarding coverage questions.</li><li>
Respond to member requests for evidence of coverage, review contracts related to evidence of coverage and provide general guidance related to the same.</li><li>
Support the provision of pre-claim investigation and special education services as authorized under the coverage agreement.</li><li>
Provide risk management support and services to Risk Co-Op member districts, under the supervision of the Assistant Superintendent or Risk Management and Member Services Manager.</li><li>
Travel to school districts across Southwest Washington to evaluate or investigate claims or to provide risk management and member services support.</li><li>
Maintain regular attendance to carry out the duties and responsibilities of the position.</li></ul>
Other Functions:<ul><li>
Participate in training and professional development related to claims handling, public entity risk, and school district risk management and claims administration.</li><li>
Ensure compliance with internal policies, procedures, regulatory requirements and best practices.</li><li>
Work with the Insurance Programs and Risk Management coordinator on assigned Risk Co-Op projects or recurring activities.</li><li>
Other duties as assigned.</li></ul></div>
<div><h2 class="jobSectionHeader">Minimum/Preferred Qualifications &amp; Skills</h2></div>
<div>Minimum Qualifications:<ul><li><div>
Bachelor's degree in business, risk management, public administration, or related field.</div></li><li><div>
2 years of experience in insurance, claims, customer service, or public sector work.</div></li><li><div>
Basic understanding of property and casualty insurance concepts.</div></li><li><div>
Experience with claims systems or similar data processing systems.</div></li><li><div>
Valid drivers' license</div></li></ul>
Preferred Qualifications:<ul><li><div>
Experience with public entity pools.</div></li><li><div>
Experience investigating or working with covered individuals on property or casualty claims.</div></li><li><div>
Current knowledge of case law, legislation and general developments pertaining to claims matters.</div></li><li><div>
Claims adjuster license or professional certifications (AIC or ARM).</div></li></ul><div> 
.</div></div> 

<div><h2 class="jobSectionHeader">Working Conditions/Employment Requirements</h2></div>
<div>Working Conditions<ul><li>
Extensive travel, including occasional overnight stays.</li><li>
Flexible work hours, on call evenings, weekend, and holidays.</li><li>
Inspect facilities and equipment (such as fire scenes) where hazardous conditions may exist, sometimes in adverse weather conditions.</li><li>
Activities include, but not limited to: climbing ladders, crawling into areas with low ceilings, walking on uneven surfaces, walking on catwalks, walking through flooded areas.</li></ul>
Employment Requirements<ul><li>
Successful completion of a criminal history check and fingerprint check through the WA State Patrol and FBI.</li></ul></div> 

</div><div></div><div><div>Notice of Non-Discrimination 
ESD 112 does not discriminate in any programs or activities on the basis of race, religion, creed, color, sex, national origin, marital status, sexual orientation, gender expression or identity, age, honorably discharged veteran or military status, the presence of any sensory, mental, or physical disability, or the use of a trained guide dog or service animal by a disabled person. The following individuals have been designated to handle questions and complaints of alleged discrimination:
<ul><li>Civil Rights compliance Officer: Melissa Kreuder, 360-952-3328, melissa.kreuder@esd112.org</li>
<li>Title IX Compliance Officer: Wendy Niehaus, 360-952-3574, wendy.niehaus@esd112.org</li>
<li>ADA/504 Compliance Officer: Jeffrey Niess, 360-952-3529, jeffrey.niess@esd112.org</li>
</ul>
The above information will be provided in the appropriate language for persons with limited English language skills by contacting the ESD at 360-750-7500.</div></div></div>

Risk Co-Op Property/Casualty Claim Adjuster

JOB
 Under the general direction of the Senior Claims Administrator and the Risk Management and Member Services Manager, the claims adjuster supports investigation, evaluation, and resolution of property and casualty claims for the SW Washington Risk Management and Insurance Cooperative and provides support and assistance with risk management and member services activities.Salary: The full range for this position is $32.89-$40.02 per hour. Offers are made at the beginning of the range.Assignment: This position is year round and will work a minimum of 20 hrs/week with potential of up to 40 hrs/week. A complete application will include: Work history going back 10 years (if applicable) At least three professional reference's contact informationA Cover Letter expressing interest in the positionA Resume that reflects work experience listed on applicationProof of your degree.This position is open until filled with applications received by 5:00 p.m. on Wednesday, April 20, 2026 receiving first consideration.
 
EXAMPLE OF DUTIES
 Essential Functions: Assist in the intake, review, and processing of new property and casualty claims, including maintain accurate and timely claim file documentation in claims management systems, determining appropriate reserves and tracking claims.Coordinate inspections, appraisals and repairs for property losses.Support claim investigations by gathering facts, statements, reports, photos and documentation.Communicate with claimants, vendors, internal staff, and school district personnel in a timely and professional manner. Prepare correspondence, reports, and claims summaries.Help evaluate coverage, liability and damages under the supervision of the Assistant Superintendent or Sr Claims Administrator and consult with Risk Co-Op member districts regarding coverage questions.Respond to member requests for evidence of coverage, review contracts related to evidence of coverage and provide general guidance related to the same.Support the provision of pre-claim investigation and special education services as authorized under the coverage agreement.Provide risk management support and services to Risk Co-Op member districts, under the supervision of the Assistant Superintendent or Risk Management and Member Services Manager. Travel to school districts across Southwest Washington to evaluate or investigate claims or to provide risk management and member services support. Maintain regular attendance to carry out the duties and responsibilities of the position.Other Functions: Participate in training and professional development related to claims handling, public entity risk, and school district risk management and claims administration. Ensure compliance with internal policies, procedures, regulatory requirements and best practices.Work with the Insurance Programs and Risk Management coordinator on assigned Risk Co-Op projects or recurring activities.Other duties as assigned.
 
SUPPLEMENTAL INFORMATION
 Working ConditionsExtensive travel, including occasional overnight stays.Flexible work hours, on call evenings, weekend, and holidays.Inspect facilities and equipment (such as fire scenes) where hazardous conditions may exist, sometimes in adverse weather conditions.Activities include, but not limited to: climbing ladders, crawling into areas with low ceilings, walking on uneven surfaces, walking on catwalks, walking through flooded areas.Employment RequirementsSuccessful completion of a criminal history check and fingerprint check through the WA State Patrol and FBI.

EMA Risk Services

EMA Risk Services is a third-party administrator handling transportation claims. We are looking to hire in our Phoenix, AZ office - as well as our San Antonio, TX office.We&rsquo;re looking for a Bodily Injury Claims Adjuster who is confident investigating, evaluating, and negotiating BI claims&mdash;while communicating professionally with policyholders, claimants, attorneys, and medical providers to drive appropriate resolutions.What You&rsquo;ll Do&middot; Investigate, evaluate, and negotiate bodily injury claims from start to resolution&middot; Communicate directly with policyholders, claimants, attorneys, and medical professionals&middot; Apply insurance principles and regulatory knowledge to support proper claim handling&middot; Maintain clear documentation and organized claim filesQualifications&middot; Excellent communication and negotiation skills&middot; Strong attention to detail and analytical abilities&middot; Knowledge of insurance principles and regulations&middot; Bodily injury claims experience preferred&middot; Ability to work independently and as part of a teamCompensation &amp; Benefits&middot; Competitive pay&middot; Full benefits&middot; RetirementBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: In person

Bodily Injury Claims Adjuster

AAA Auto Club Enterprises

Job Summary
 
The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims.
 
Job Duties
 
Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses.
 
Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.
 
Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
 
Negotiate within settlement authority with insureds and claimants to resolve first and third party claims.
 
Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
 
Control expenses for areas of responsibility.
 
Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
 
Respond quickly to customer needs and problems.
 
Independently resolve claims within authority level.
 
Qualifications
 
Bachelors Equivalent combination of education and experience Preferred
 
7-9 years Prior claims handling experience. Preferred
 
4-6 years Property, Auto, Casualty or relevant claims administration experience. Required
 
Comprehensive knowledge of claims administration best practices and procedures.
 
Advanced knowledge of insurance, fault assessment, negligence and subrogation principles required.
 
Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
 
Advanced knowledge of Microsoft Office suite, general computer software and claims software.
 
Advanced organization and planning recognition skills required.
 
Advanced oral and written communication skills required.
 
Advanced interpersonal skills required.
 
Advanced leadership skills among peers required.
 
Exhibit proficiency and understanding of medical terminology and causality
 
Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
 
Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
 
Associate in Claims - Insurance Institute of America Preferred
 
An insurance/claims adjuster license may be required for claims administration in specific states.
 
Travel Requirements
 
Occasional travel to business meetings or conferences.
 
The starting pay range for this position is: 
$38.64 - $51.46
 Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.
 .
 
Remarkable benefits: 
<ul>
<li>Health coverage for medical, dental, vision</li>
<li>401(K) saving plans with company match AND Pension</li>
<li>Tuition assistance</li>
<li>Floating holidays and PTO for community volunteer programs</li>
<li>Paid parental leave</li>
<li>Wellness programs</li>
<li>Employee discounts (membership, insurance,</li>
</ul>
travel, entertainment, services and more!)
 
Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
 
“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
 
AAA is an Equal Opportunity Employer
 
Our organization participates in E-Verify
 
The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

Claims Senior Casualty Adjuster

CSAA Insurance Group, a AAA Insurer

<div>External candidates: In order for your application to be correctly processed please sign-in before you apply
Internal candidates: Please go to Workday and click &quot;Find Jobs&quot; link under Career
Thank you for considering opportunities with us!
Job Title
Commercial Casualty Litigation Adjuster II - Remote
Requisition Number
R7661 Commercial Casualty Litigation Adjuster II - Remote (Open)
Location
Colorado - Home Teleworkers
Additional Locations
Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers, Nebraska - Home Teleworkers {+ 19 more}
Job Information
We're Mobilitas, a commercial insurance company created by CSAA Insurance Group. Our mission is to reinvent commercial insurance in the mobility space to offer our partners innovative solutions for today&rsquo;s way of doing business. At Mobilitas, we believe in what's possible and we use our inventive skills to meet the demands of modern mobility with exceptional service. We&rsquo;re looking for motivated, innovative individuals who think big, move fast and are dedicated to creating a company from the ground up, without the constraints of a traditional insurance company. We&rsquo;re excited to push the boundaries of commercial insurance and are looking for enthusiastic team members to help us reimagine insurance.
We are actively hiring for a Commercial Casualty Litigation Adjuster II- Remote
Your Role: As a Commercial Casualty Litigation Adjuster II, you will be assigned as owning adjuster when injury exposures are identified. Claims will include catastrophic injuries, fatalities, and litigation. In this role, you will be responsible for management of the claim through conclusion, including trial, of litigated claims. May own claims within other specialized lines of business or during catastrophes. You will provide input and direction to defense counsel and be responsible for ultimate resolution through providing settlement authority and participating in negotiations with limited oversight. You will also be responsible for effective management of defense costs and indemnity. May handle first party non-liability-based injury claim (Medical Payment, PIP, Inland Marine, auto physical damage).<h2 class="jobSectionHeader">
Your Work:
</h2><ul><li>Assigned as owning adjuster when injury exposure is identified.</li><li>
Handles complex 1st and 3rd party auto liability cases involving injury, including complexity litigated cases with defense attorney involvement.</li><li>
May handle 1st party medical payment and PIP claims.</li><li>
Responsible for managing, investigating, and negotiating claims, including collaborating with defense counsel to identify strategy for negotiations. Provides input as the face of the organization via phone or in attendance on video or in-person at mediations and settlement conferences for litigation claims.</li><li>
Interacts directly with defense counsel providing direction, authority for resolution (i.e., settle or go to trial) and ensures appropriate outcome in balancing defense costs and indemnity on litigation claims.</li><li>
Making coverage determinations and advising customers as to proper course of action related to coverage issues.</li><li>
Conducting investigative work of a complex nature (interviewing witnesses; obtaining and analyzing evidence, including medical records; deciding whether an independent medical examination is warranted; etc.).</li><li>
Direct defense counsel in non-litigated or litigated claims.</li><li>
May require appearing at and representing the insureds at arbitrations and trials.</li><li>
May require testimony in a deposition setting.</li><li>
Evaluate defense counsel fees and cost for reasonableness and resolve.</li><li>
Evaluating potential for subrogation and initiating initial notice of subrogation request.</li><li>
Making final decisions to settle within settlement authority, without supervisory approval, and developing negotiating strategies.</li><li>
Presenting cases in Committee setting when seeking above settlement authority level; thereafter, independently negotiating and settling the claim.</li><li>
Will develop and present executive summaries on individual claims to external clients and internal executives in a virtual setting to gain alignment with client on next steps, and settlements.</li><li>
Handles most commercial product types including but not limited to auto, fleet, last mile delivery, and trucking. Will handle claims in most geographic venues. Handles claims involving any vehicle types that may include, but is not limited to auto, motorcycles, scooters, recreational vehicles, trucks, and remote-controlled delivery vehicles.</li><li>
Understands and handles claims in line with any applicable insurance program agreements, claim service level agreements.</li><li>
Plays a direct role in the development of other adjusters through mentorship, training, and coaching.</li></ul><h2 class="jobSectionHeader">
Required Experience, Education and Skills:</h2><ul><li>
6+ years of claims experience.</li><li>
4+ years of experience in commercial claims role and 2+ years in litigation handling within P&amp;C insurance industry.</li><li>
BA/BS in business, insurance or related area, or equivalent combination of education and experience.</li><li>
Must hold an Adjuster licensed for all applicable states or obtain license(s) within 90 days of filling position as a condition of employment.</li></ul>
What would make us excited about you:<ul><li>
6+ years of Casualty claims adjusters experience.</li><li>
3+ years of experience in a Commercial claims role</li><li>
Bilingual a plus.</li><li>
Proficiency or ability to obtain proficiency in the handling of minor, moderate and complex litigated claims.</li><li>
Strong analytical, problem-solving, and organizational skills.</li><li>
Proficient in ability to work independently.</li><li>
Strong decision-making ability.</li><li>
Extensive understanding of statutory and regulatory requirements, and ability to develop proficiency in standards of civil procedure.</li><li>
Ability to travel and to work extended hours and/or weekends.</li><li>
Proficient oral and written communication skills and ability to organize and present complex facts to executive management.</li><li>
Strong math skills, basic computer skills and ability to type at least 30 words per minute.</li></ul>
Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska.
Why Choose a Career at Mobilitas?
At Mobilitas, we are a mission-driven organization proudly committed to empowering our members, our employees, and our communities to thrive.
Recognition: We offer a total compensation package, annual bonus eligibility for most roles, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at careers.mobilitasinsurance.com.
Career Growth: We believe in growth for everyone. Here at Mobilitas, leaders and mentors partner with employees to align interests, unlock development opportunities, and support long‑term success.
Flexible Workplace: We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex roles, working primarily from home, often with the flexibility to work from various locations including Mobilitas offices. Our flexible workplace empowers you to balance remote work with intentional in‑person moments that deepen connection and collaboration.
Inclusion and Belonging: An inclusive and welcoming workplace is the cornerstone of our success. By fostering an environment where people feel valued and heard, we deepen our ability to understand and meet the unique needs of our members. This strengthens innovation and enhances our products and services, giving us a competitive edge in the market.
Sustainability: As climate change leads to more frequent and severe weather events, we are taking bold action to build more resilient communities and reduce our environmental impact.
Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don&rsquo;t miss important updates from us.
CSAA is committed to providing reasonable accommodations to qualified applicants and employees with disabilities or other limitations. If you would like to request an accommodation to participate in the job application or interview process, please contact jobs@mobilitasinsurance.com
If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education.
Mobilitas does not provide visa sponsorship for this role. Applicants must have authorization to work indefinitely in the US. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Mobilitas Insurance Group is an equal opportunity employer.
#LI-CH1
#HP_RX
.
The national average salary range for this position is $89,865.00-$99,850.00. However, we have a location-based compensation structure. Our salary ranges vary and are calculated based on work location. The starting pay range for this position across all the states we hire in is $89,865.00-$119,800.00. This role also includes an opportunity for a company-wide annual discretionary bonus, through our Annual Incentive Plan (AIP), of up to 12% of eligible pay.
This job posting will be unposted on Sat, 18 Apr 2026.</div>

Commercial Casualty Litigation Adjuster II - Remote

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Hourly Casualty Adjuster
PRIMARY PURPOSE : To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications, along with financial implications and to mentor Account Representatives and Account Specialists.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Utilizes special account instructions to obtain individual customer information and adhere to instructions; identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
</li><li>Establishes and maintains effective relationship with internal and external customers and coworkers; communicates effectively and timely.
</li><li>Mentors/coaches account representatives and account specialists; facilitates round table discussions within the assigned team.
</li><li>Investigates, evaluates and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations; interprets medical reports and state law or jurisdictional law in claim handling.
</li><li>Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
</li><li>Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
</li><li>Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve claims.
</li><li>Ensures compliance and best possible outcomes by minimizing financial liability.
</li><li>Compiles requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines.
</li><li>Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team&rsquo;s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul>QUALIFICATIONS
Education &amp; Licensing
 
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.
Experience
 
Six (6) years of related experience and/or training or equivalent combination of education and experience required.
Skills &amp; Knowledge
<ul><li>Thorough legal and jurisdictional knowledge based on line of business
</li><li>Strong oral and written communication, including presentation skills
</li><li>PC literate, including Microsoft Office products
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Excellent interpersonal skills
</li><li>Strong customer service skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Performance Competencies
</li></ul>WORK ENVIRONMENT
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Hourly Casualty Adjuster

Search 1619+ Claim adjuster jobs near you this April. New roles added regularly across leading industries. Apply today.

1619 claim adjuster jobs Near Me

Workers’ Compensation Claim Adjuster

Risk Co-Op Property/Casualty Claim Adjuster

Risk Co-Op Property/Casualty Claim Adjuster

Bodily Injury Claims Adjuster

Claims Senior Casualty Adjuster

Commercial Casualty Litigation Adjuster II - Remote

Hourly Casualty Adjuster