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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex claims, interpreting legal and jurisdictional requirements, and ensuring compliance while maintaining strong relationships with clients and team members. Proficient in analytical skills and effective communication to facilitate collaboration and problem-solving.
Highest-signal resume keywords
State Adjuster LicensesClaims ManagementLegal and Jurisdictional KnowledgeAnalytical and Interpretive SkillsCustomer Service Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims InvestigationFinancial Implications AssessmentIndemnity Exposure AssessmentMedical Report InterpretationCompliance MonitoringSAS/SOX Document ReviewCase Management ReviewSubrogation CoordinationFraud EvaluationPerformance Competencies
Soft Skills
Strong Oral CommunicationStrong Written CommunicationInterpersonal SkillsOrganizational SkillsTeam Collaboration
Tools & Technologies
Microsoft OfficeEDI SystemsClaims Management Software
Certifications & Qualifications
State Adjuster Licenses
Industry Keywords
Insurance CoverageLitigation ManagementCustomer Relationship ManagementQuality ProgramsPerformance Metrics
About the role
Key responsibilities & impact- Manage a claim caseload ranging from basic to highly complex claims within granted authority levels, including related financial implications
- Mentor and coach Account Representatives and Account Specialists
- Use special account instructions to obtain customer information and coordinate specialized services such as subrogation, fraud evaluation, and case management review
- Establish and maintain effective relationships with internal and external customers and coworkers
- Facilitate round table discussions within the assigned team
- Investigate, evaluate, and resolve claims
- Identify potential problems and trends in claim files and take corrective action or make recommendations
- Interpret medical reports, state law, jurisdictional law, and insurance coverage
- Assess indemnity, medical, and expense exposure of assigned claims
- Review client files and collaborate with the team on file strategies, claims status, and emerging trends
- Proactively manage litigation with clients and legal representatives
- Minimize financial liability and ensure compliance and favorable outcomes
- Compile requirements and ensure state-required documentation is issued accurately and timely
- Monitor compliance reports and jurisdictional requirements, including EDI and benefit-payment timeliness
- Assist the Team Lead with tracking team tasks and projects
- Review SAS/SOX documents and submit them timely
- Assist with takeover and reverse takeover projects and ensure appropriate claim-file transfer and handling
- Perform other assigned duties
- Support organizational quality programs
Requirements
What you’ll need- State adjuster licenses required
- Six (6) years of related experience and/or training or equivalent combination of education and experience required
- Bachelor's degree from an accredited college or university preferred
- Thorough legal and jurisdictional knowledge based on line of business
- Strong oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Strong customer service skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
- Ability to handle work-related stress and multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Travel as required
Benefits
Comp & perks- Work-life balance
- Reasonable accommodations when applicable and appropriate
- Equal Opportunity Employer
- Drug-Free Workplace