Staff Claims Adjuster FS

Tasks are basic and routine, relating to insurance programs that are filed with the Department of Insurance:

- Educates client/customer on policies, procedures and programs.

- Ensures customer focus by providing excellent service, providing accurate information and remaining professional on all calls.

- Gathers basic information from customer to start initial claim and enters into system following standard screens/ scripts/procedures to perform tasks.

- Analyzes documentation submitted for accuracy and completeness.

- Investigates questionable claims with management.

- Adjudicates claim as per applicable laws and policy provisions.

- Approves/Denies claim up to authority approval limit; escalates to management when needed.

- Documents all steps taken, documentation submitted and outcome in system.

- Deliver extraordinary results measured by customer satisfaction, effectiveness, efficiency, and quality.

- Establish and maintain cooperative working relationships with managers, supervisors, employees, vendors and customers.

- Generally supports one product line but may be trained on additional products.

• High School Diploma or GED equivalent
• Adjusters License or ability to obtain upon employment
• Knowledgeable in all the duties of the Adjuster I position, or similar positions.

- Knowledge of telephone and email etiquette. - Strategic-relationship/partnership-building skills -- listen attentively, solve problems creatively, and use tact and diplomacy to find common ground and drive positive outcomes. - Ability to work with multiple personality types; to gather data and facts; to keep accurate records; and to communicate effectively, both orally and in writing. - Provide effective and proactive solutions on behalf of customers when applicable selecting from a variety of established procedures to accomplish assigned tasks. - Success requires obtaining an intimate knowledge of the products and the ability explain the benefits in detail - Experience using Microsoft Office including Word, Outlook, Excel and internal internet-based processing system. - Ability to work independently, demonstrating high level of personal effectiveness. - Able to effectively assess and diffuse difficult situations. - Flexibility in work schedule needed due to varied needs of our business. - Bi-lingual preferred