Complex Major Medical Investigator
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Job Description
Complex claims investigator handling liability, coverage, valuation, and settlement of major medical and casualty claims. Supporting AAA federation members through investigations, negotiations, and claim resolution.
Responsibilities:
- Conduct phone and/or field investigations to determine liability and damages
- Attend and participate in legal proceedings as needed
- Identify and obtain statements from insureds, claimants, and witnesses
- Communicate with insureds, claimants, and other individuals
- Explain benefits, coverages, fault, and claims processes verbally or in writing in compliance with regulatory and statutory requirements
- Address complex coverage and subrogation issues
- Evaluate and determine claim values using property, bodily injury, and liability data
- Negotiate within settlement authority to resolve first- and third-party claims
- Control expenses for areas of responsibility
- Perform administrative functions and update database production reports
- Document and update claim files using company systems including CACS, HUON, HOC, and Guidewire
- Verify and interpret coverage and resolve applicability issues by gathering necessary information
- Coordinate with internal and external departments
- Mentor other adjusters on adjudicating complex claims
- Respond quickly to customer needs and problems
- Independently resolve claim exposures within level of authority
Requirements:
- 7-9 years Property, Auto, Casualty or relevant claims experience
- Comprehensive knowledge of claims administration best practices and procedures
- Advanced knowledge of insurance, fault assessment, negligence and subrogation principles
- 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
- 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
- Bachelor's degree or equivalent combination of education and experience preferred
- Prior claims experience of 10+ years preferred
- Chartered Property Casualty Underwriter preferred
- Associate in Claims preferred
- Insurance/claims adjuster license may be required for claims administration in specific states
- Occasional travel to business meetings or conferences (5%)
Benefits:
- Health coverage for medical, dental, vision
- 401(K) saving plans with company match
- Pension
- Tuition assistance
- Floating holidays and PTO for community volunteer programs
- Paid parental leave
- Wellness programs
- Employee discounts (membership, insurance, travel, entertainment, services and more!)
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