Claims Resolution Expert
5 days ago
We are seeking a highly skilled Senior Claims Adjuster to join our team at The Emerald Group Ltd, Search and Selection. As a Senior Claims Adjuster, you will be responsible for handling complex claims, including mesothelioma and other high-value claims, and ensuring timely resolution and compliance with relevant laws and regulations.
Key Responsibilities- Claims Handling: Update claims files by accurately capturing and updating claims data/information in compliance with best practices, reflecting the highest degree of technical complexity and exposure.
- Liability Determination: Use judgment to determine liability by gathering and analyzing relevant facts, utilizing applicable law, and establishing basic principles of negligence/breach of duty.
- Claims Resolution: Ensure timely resolution to claims by developing case strategy, developing a case evaluation, and escalating issues as appropriate.
- Policy Verification: Use judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
- Customer Service: Ensure customer service by proactively communicating information, responding to inquiries following customer service protocols.
- Litigation Management: 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 authorizing payments.
- Legal Compliance: Ensure legal compliance by following applicable laws and regulations and internal control requirements.
- Contribution and Recovery: Ensure contributions and recoveries secured.
- Fraud Identification: Refer claim to manager where potential fraud identified.
- Risk Insight: Contribute to profitable growth by providing risk insight, information, and trends/emerging risks.
- Technical Expertise: Serve as a technical resource by mentoring lower-level claims professionals and sharing technical knowledge related to specific Line of Business expertise.
- Reputation Protection: Protect the organization's reputation by keeping claims information confidential and treating customers fairly.
- Professional Development: Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Team Contribution: Contribute to the team effort by accomplishing related results and participating in projects as needed.
- Problem Resolution: Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
- Technical Expert: Act as a technical expert for own team.
- Development Management: Takes responsibility for managing own development.
- Senior Colleague Consultation: Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and continuous learning.
- Corporate Values: Model behavior demonstrating commitment to corporate values and teamwork.
- Industry Knowledge: Keeping abreast of Legal, Regulatory, and Medical developments.
- Claims Management: Having a proactive approach to claims management and early settlement of claims to minimize life cycle of claims and liability to solicitors' costs.
- Policy Obligations: 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.
- Reporting: Providing clear and concise written and verbal reports to senior management.
- Experience: Experience handling mesothelioma claims.
- Technical Knowledge: Demonstrates familiarization of related technical issues and up-to-date knowledge and experience.
- Leadership: Practical experience in leading or working in external claims inspections.
- Communication Skills: Articulate, computer literate, and numerate with the ability to write concise and meaningful reports.
- Analytical Skills: Strong analytical skills.
- Settlement Ability: Ability to settle claims within agreed guidelines.
- Autonomy: Self-motivated with the ability to work autonomously.
- Development: Takes responsibility for managing own development.
- Teamwork: Team-oriented working manner.
- Communication: Approachable, responsive, flexible, and able to communicate at all levels.
- Required: GCSE Maths and English Grade C or above, 5 years disease claims handling experience. Experience of handling mesothelioma and other high-value claims with reserves over £250k.
- Preferred: CII/CILA/Bachelor's degree (or equivalent), some mentoring experience.
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