Under general supervision investigates, evaluates and concludes complex claims in one or more of the following categories: Property, Casualty Property Damage, Bodily Injury, No-Fault and Medical Pay, Auto Physical Damage Comprehensive and Minor Collision and Recovery, i.e. all aspects of assigned of Energy Clients, General Commercial Risk clients and Public Entity casualty claims handling from inception to conclusion within established TRISTAR authority and guidelines.
Reserve authority: $5000.00
Settlement authority: $5000.00
Payment authority: $5000.00
This position requires considerable interaction with clients, claimants on the phone and sometimes on site investigations, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being Client Service focused, at work in a timely manner, being well organized and detailed is inherently required of this position. Must also be able to read/comprehend polices and determine coverages. Compliance with client handling instructions in addition to TRISTAR Best Practices and SOC 1 is a must.
DUTIES AND RESPONSIBILITIES:
- Effectively manages an average caseload of 110 to 145 Casualty suffixes, including complex and non complex based upon designated account needs.*
- Initiates and conducts claims investigation in a timely manner per client CHI’s, Tristar BP and SOC 1.*
- Evaluate policy clauses; determines coverage; secure information using telephone and written correspondence from clients, claimants, witnesses, investigating authorities, agents, experts and doctors, attorney’s etc…
- Verify facts and damages; documenting the files as per BP / SOC 1.
- Refers cases to outside defense counsel as appropriate. Monitors legal aspects.*maintains suit, arbitration and hearing logs. Recommends referral of cases to legal counsel, investigators within client authority. Supervises litigation activities, Monitors for adherence to litigation budget as required.
- Maintain current and valid required state adjusting licenses for claims assigned.
- Communicates with claimants, providers and vendors regarding claims issues.*Preparing and submitting required reports such as Formal Status reports, Excess Reports and or Captioned reports.
- Computes and set reserves within Company guidelines for CEIII and as required by client claim handling instructions (CHI’s)
- Settles and/or finalize all claims and obtains appropriate releases within authority of CEIII subject to authority outlined in various client claim handling instructions.
- Maintains diary system for case review and document file to reflect the status and work being performed on the file.*
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
- Adheres to all Company policies and procedures.*
- Participates in file reviews, as needed.
- May participate in some work outside consisting of customer service calls, claim site investigations, mediations, depositions and or court appearances.
- Particpate in in-house training.
- Maintain professional customer relationship.
- Other duties as assigned.
*All of the above are Essential job functions.
- Have a good sense of urgency
- Ability to get along well with others.
- Bi-lingual would be a plus but not required.