Claims Examiner, Auto – Bodily Injury

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Evaluate complex or technically challenging auto and general liability claims to ascertain benefits owed.

• Manage high exposure claims that involve litigation and rehabilitation processes.

• Ensure continuous adjudication of claims aligns with service expectations, industry best practices, and client service standards.

• Identify subrogation opportunities and negotiate settlements effectively.

• Investigate and collect information to evaluate claim exposure thoroughly.

• Oversee claims using action plans to achieve timely resolutions.

• Assess liability and resolve claims during the evaluation phase.

• Negotiate settlements within the established authority limits.

• Calculate and allocate reserves while ensuring their adequacy is maintained.

• Calculate and disburse benefits, approve claim payments and adjustments, and finalize claims.

• Prepare all necessary state filings within statutory timelines.

• Manage the litigation process efficiently.

• Coordinate vendor referrals for investigation and litigation management purposes.

• Employ cost containment strategies and leverage vendor partnerships.

• Oversee claim recoveries, including subrogation, Second Injury Fund excess recoveries, and offsets from Social Security and Medicare.

• Report claims to the excess carrier and respond to any direction requests.

• Communicate ongoing claim activities with claimants and clients effectively.

• Maintain professional relationships with clients.

• Ensure claim files are well-documented and that claim coding is accurate.

• Refer cases to supervisors and management when appropriate.

• Support the organization's quality programs as needed.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of five (5) years of claims management experience or a relevant combination of education and experience is required.

• Comprehensive knowledge of personal and commercial auto policies, coverages, principles, and relevant laws.

• Strong oral and written communication skills, including proficiency in presentation delivery.

• Proficient in PC usage, including Microsoft Office applications.

• Ability to work collaboratively in a team environment.

• Must secure and maintain the necessary state adjusting licenses for the position.

• Proficient in computer keyboarding.

• Ability to hear, see, and speak clearly.

• Capable of clear and conceptual thinking.

• Excellent judgment and discretion in decision-making.

• Ability to meet deadlines consistently.

🏝️ Benefits

• Work-life balance.

• Supportive and caring workplace culture.

• Equal Opportunity Employer.

• Drug-Free Workplace policy.

• Commitment to a diverse, equitable, and inclusive work environment.