Claims Adjuster

Summary: The primary responsibility of this position is to analyze complex or technically difficult general liability and workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. The adjuster is responsible for the prompt and efficient examination, investigation, settlement, or declination of commercial insurance claims through effective research, negotiation, and interaction with insurers and claimants, ensuring that company resources are utilized in a cost-effective manner in the process. This may include negotiating property, injury, workers' compensation, and subrogation claims and managing the City's relationships with third-party administrators, independent adjusters, legal counsel, various experts, and suppliers. The position will be assigned specific objectives, including reporting, resolving claims, and returning injured employees to work as quickly as possible, maximizing financial recovery, and proactively minimizing financial exposure. The position has responsibility in all areas of claims management.

Essential Functions: Essential duties and responsibilities may include, but are not limited to, the following:

Analyze, review, and interpret policies to assess coverage and liability.
Negotiates settlement of claims within designated authority.
Determine and facilitate or perform the necessary level of investigation on complicated claims to bring a claim to an equitable conclusion for all parties involved.
Properly document information in the claim file and drafts coverage letters, including reservation of rights and denial letters.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Investigate each claim by verifying and reviewing damages to determine the root cause. Identify fraudulent claims and lead investigations.
Determine the applicability of coverage and liability.
Ensures timely and cost-effective claims resolution.
Identifies emerging exposure and leads safety training initiatives.
Participate in contract renewals and budgeting.
Inspect property damage and physical injuries.
Interview witnesses to understand the nature of the claim and understand any relevant preceding events.
Consult with outside experts such as engineers, physicians, and lawyers.
Analyze complex information from different sources.
Examine police reports, video footage, audio, and other pertinent information to understand the incident further.
Prepare and process the claim report detailing the events and damage related to the claim
Review insurance policies and Texas Tort laws to determine coverage
Under basic supervision, investigate, examine, and adjudicate liability and property damage claims against the City.
Coordinate the services of approved third-party vendors to ensure damage is repaired.
Negotiate claims settlements with claimants and their legal teams.
Support internal and external legal teams to defend the City in contested cases.
Pursue subrogation claims on behalf of the City.
Supervise support staff as required or needed.
Develop aggregate reports for leadership review.
Maintain confidentiality of information.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Refers cases as appropriate to supervisor and management.
Other duties may be required as indicated by professional judgement or as assigned.

Essential functions, as defined under the Americans with Disabilities Act, may include any of the representative duties, knowledge, and skills. This is not a comprehensive listing of all functions and duties performed by incumbents of this class; employees may be assigned duties which are not listed; reasonable accommodations will be made as required. The job description does not constitute an employment agreement and is subject to change at any time by the employer.

Minimum Qualifications:

Education, Training, and Experience Guidelines: A four-year degree from an accredited institution or equivalent experience. (5) years of experience handling claims, including advanced skills in coverage, investigation, litigation, workers' compensation, negotiation, damage/injury evaluation, salvage, and subrogation.

Knowledge, Skills, and Abilities:

Knowledge of and adherence to Texas state laws and regulations governing the handling of general liability, property, and workers' compensation claims.
Ability to demonstrate time management skills, communication skills, verbal and written, and strong computer skills.
Knowledge of liability and workers compensation claims, mathematics, construction, auto physical damage, workers' compensation, medical terms, and legal issues.
Knowledge of principles of claim adjudication and administration.
Ability to analyze various courses of action and make recommendations.
Skill in communicating using audience appropriate language and techniques.
Ability to demonstrate strong analytical and mathematical skills to evaluate complex claims properly.
Skilled and experienced with negotiations.
Ability to demonstrate an appropriate level of detail orientation.
Ability to write clear and detailed reports.
Ability to demonstrate and acquire appropriate computer skills.
Ability to demonstrate effective time management skills.
Ability to demonstrate appropriate interpersonal skills, compassion, and resilience in the performance of the duties.

License and certification requirements: A valid Texas Department of Insurance all-lines adjuster license is required.

Physical demands and working environments: The employee is required to perform sedentary work as well as work involving some physical effort. The employee must be physically able to perform those duties requiring the ability to walk, climb, stoop, and lift, must demonstrate adequate vision and dexterity, and must speak and hear to the degree necessary to communicate with others and to conduct training. This position will perform duties both in a standard office environment as well as in a variety of field locations and must be able to transition between sites frequently during the workday. Although the duties are generally performed on weekdays during business hours, occasional variations such as holiday, night, and weekend work may be required.

Disclaimer: This is an in-person position. Remote or hybrid work arrangements are not available. Candidates must be able to work on-site at the designated location for the duration of employment."

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