Claims Specialist - Tier 2 (Risk Management)

Duties and Responsibilities

Note: The following duties are illustrative and not exhaustive. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. Depending on assigned area of responsibility, incumbents in the position may perform some or all the activities described below. 

• Conduct comprehensive investigations of losses using appropriate techniques, including interviews, recorded statements, documentation and data gathering, and securing/preserving evidence.
• Verify, analyze, and accurately apply coverage in accordance with County policies and applicable laws.
• Develop strategies for claim resolution and negotiate settlements to achieve timely conclusions.
• Determine the appropriate outcome of claims (e.g., pay, deny, compromise) based on analysis of facts, liability, and statutory/case law.
• Assess the need for and provide directions to third-party administrators (TPA), legal counsel, or other technical experts.
• Monitor and control claims costs to ensure cost-effective outcomes.
• Evaluate liability and damages, identifying subrogation, salvage, or fraud/suspicious claim opportunities.
• Prepare timely, accurate, and concise reports as required.
• Promptly establish and maintain accurate reserves throughout the life of the claim.
• Performs other related duties as required.

Job Specifications

• Ability to adjust complex Commercial Automobile and Liability claims to proper conclusion, including handling complex litigation and coverage issues.
• Demonstrated proficiency in interviewing, problem solving, communication (verbal and written), and time management and conflict resolution skills.
• Must be service oriented with the ability to work in a team environment, collaborate with others and build strong customer relationships.
• Ability to apply computer applications and use related software.
• Knowledge of statutes, case law and standardized practices, regulations and ordinances applicable to multi-line claims administration.
• Knowledge of insurance principles, procedures, government self-insurance programs and industry practices.
• Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Understands the implications of new information for both current and future problem-solving and decision-making
• Ability to communicate with internal and external customers -- represents the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.

Physical Requirements

• Position is typically in an office environment. 
• Requires an employee to be mostly sedentary. 
• This position may occasionally require travel to field sites to conduct job-related inspections, investigations, or other duties.

Work Category

• Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg control requires exertion of forces greater than that of sedentary work and if the worker sits most of the time, the job is considered light work.

Minimum Qualifications Required

• Graduation from an accredited four-year college or university in a related field of work; AND
• Two (2) years of experience directly related to the duties listed above.

• Three (3) plus years of adjusting complex Commercial Automobile and Liability claims to proper conclusion, including handling complex litigation and coverage issues preferred.

  OR

• An equivalent combination of education, training and experience that would reasonably be expected to provide the job-related competencies noted below. (For education and experience only, does not include legally required Licenses or Certifications.); AND
• 620 Independent Adjuster license or equivalent (must be able to renew and self-appoint every two years).

Additional Requirements for some positions