Claims Adjuster, Self-Insurance Pool (Auto, Medical) – Direct Hire

Job Type: 
Office Services and Support
Other Office Support Positions
Clerical Support
Administrative Support
Customer Service and Help Desk
Employment Category: 
Direct Hire

Our client, a Raleigh area organization that supports school boards across the state, has an immediate need for a knowledgeable and self-directed Claims Adjuster to join its Risk Management team.  

This is a direct hire position and an immediate need.  Compensation will be generous.

Key Things to Note:

Ø  This organization provides a variety of services for the school boards that join, including insurance.  They are self-insured and maintain an insurance pool for all members.

Ø  Claims are typically automobile (school activity busses, maintenance vehicles) or medical (no fault incidents) claims.  Seek candidate with familiarity with both, with particular strength in auto.

Ø  The organization is revamping/enhancing its claims processing systems, with increasing reliance on on-line processing.  Seek candidate who can contribute to the process improvement efforts.

Ø  This is a highly collaborative group.  Seek independent worker who also enjoys being part of a team.

Ø  This is a hybrid role with 3 days being in-office at its Raleigh location.

The role will involve performing technical and administrative work associated with processing medical payment claims, automobile liability claims and automobile property and physical damage claims, on behalf of members.

Selected duties:

Ø  Receives reports of incidents and develops and maintains event and/or claim files for reported incidents. 

Ø  Conducts investigation of incidents/accidents giving rise to claims, including conferring with claimants, witnesses, medical professionals, legal professionals, and other parties as warranted to obtain data and/or resolve discrepancies 

Ø  Confers with fund members regarding coverage issues that arise and conducts necessary research to evaluate and respond to coverage questions.

Ø  Reviews and evaluates claims; confers with members and with claimants and/or their representatives to determine amount to be paid under the terms of the coverage agreement, negotiate a claim settlement where appropriate, and to determine whether the claim is one to be denied

Ø  Prepares and transmits correspondence to advise claimants and/or other appropriate parties of settlement offers, claim payment process or claim denial; assists with preparation and mailing of checks for payment 

Ø  Responds to inquiries from Association members pertaining to risk management program policies, 

Ø  Assists Litigation Counsel with necessary investigation in automobile litigation files, as requested.

Targeted candidate will offer a related degree and 3+ years of experience in adjusting automobile claims, medical claims, workers’ compensation claims. Some auto is required.  

Other priorities include:

Ø  Knowledge of common insurance claim investigation methodology

Ø  Knowledge of laws, rules and regulations governing member-funded risk management programs 

Ø  Knowledge of terms and practices related to automobile claims as well as knowledge of automobiles, the repair of automobiles and the forms and documents routinely required by the DMV in processing damage claims.       

Ø  Knowledge of injuries and symptoms commonly related to workers’ compensation, general liability, automobile liability or accidental injury claims.

Ø  Ability to analyze and interpret medical records, narrative reports, and policy and procedural guidelines to make administrative decisions, and to solve problems and answer questions.

Ø  Excellent organizational skills

Ø  Ability to obtain NC Insurance Adjuster’s license in near-term

Finally, we seek a collaborative and reliable team player who will work with both colleagues and clients in a congenial and responsive manner; Someone who has excellent communications skills, can sooth worried callers and can help resolve complex and sometimes confusing problems.

This is an immediate need.  Please forward resume for prompt consideration.  Local candidates only.