Senior Claims Adjuster

The Senior Claims Adjuster is responsible for ensuring the efficient and effective management / settlement of claims involving a high degree of technical complexity in specified lines of business; as well as the development and execution of proactive claim management strategies.

Key Responsibilities

• Update claims file by accurately capturing and updating claims data/information in compliance with best practices reflecting the highest degree of technical complexity and exposure.
• Use judgment to determine liability by gathering and analysing relevant facts, utilising applicable law and establishing basic principles of negligence/breach of duty.
• Able to handle substantial volume of high value and highly complex claims; comfortable with making and supporting own decisions; with a minimal level of guidance and direction
• Use judgment to determine policy verification and coverage determination by analysing applicable coverage for claims and determining whether the loss falls within the coverage.
• Ensure a timely resolution to claims by developing case strategy, developing a case evaluation and escalating issues as appropriate.
• Comply with relevant SLAs at all times
• Establish timely reserves outlined in SLAs, and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within your own authority limits, or within the referral structure for claims above your authority.
• Ensure customer service by proactively communicating information, responding to enquiries following customer service protocols.

Manage litigation by instructing the approved panel where applicable, establishing litigation plan and budget, coordinating panel lawyer activities, continuously reviewing the potential for settlement, reviewing litigation expenses and authorising payments.

• Ensure legal compliance by following applicable laws and regulations and internal control requirements.
• Ensure contributions and recoveries secured
• Refer claim to manager where potential fraud identified.
• Contribute to profitable growth by providing risk insight, information and trends/emerging risks
• Serve as a technical resource by mentoring lower level claims professionals and sharing technical knowledge related to specific Line of Business expertise.
• Protect the organization´s reputation by keeping claims information confidential and treating customers fairly
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks and participating in professional societies.
• Contribute to the team effort by accomplishing related results and participating in projects as needed.
• Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
• Act as a technical expert for own team
• Takes responsibility for managing own development
• Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and continuous learning.
• Model behaviour demonstrating commitment to corporate values and teamwork.
• Keeping abreast of Legal, Regulatory and Medical developments
• Having a pro-active approach to claims management and early settlement of claims to minimise life cycle of claims and liability to solicitors costs;
• Prime emphasis will be on ensuring all valid policy obligations are appropriately met, Customers are Treated Fairly and requirements under applicable Conduct obligations are discharged;
• Providing clear and concise written and verbal reports to senior management;
• May be required to participate in audits/due diligence
• May be required to participate in Policyholder meetings

Position is expected to comply with and ensure all compliance requirements, maintain confidentiality at all times, as well as serve as company representative to model, enforce and abide by all company policies.

Candidate Profile

• Demonstrates familiarisation of related technical issues and up to date knowledge and experience;
• Practical experience in leading or working in external claims inspections;
• Articulate, computer literate and numerate with the ability to write concise and meaningful reports;
• Strong analytical skills;
• Ability to settle claims within agreed guidelines;
• Self-motivated with the ability to work autonomously;
• Takes responsibility for managing own development;
• Team oriented working manner;
• Approachable, responsive, flexible and able to communicate at all levels;

Qualifications And Experience

• Required – GCSE Maths and English Grade C or above or equivalent, disease claims handling experience. Experience of handling mesothelioma and other high value disease claims.
• Preferred – CII/CILA/Bachelor’s degree (or equivalent), some mentoring experience

Skills

• Strong negotiation skills;
• Willingness to learn and share knowledge;
• Makes time to coach and develop others;
• Effective planning and organising;
• Focus on completion and achieving agreed deliverables;
• Recognises limitations and seeks support when necessary;
• Prioritises effectively;
• Progressive in approach and willing to identify and pursue improvements in what they do and work with a growing organisation;
• Demonstrated proactive approach.

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