A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
The Claims Specialist is responsible for adjusting and resolving basic claims within their authority level by investigating losses and claims, negotiating settlements, and, when appropriate, denying claims. The Claims Specialist works in tandem with the Senior Claims Department personnel for file management ensuring the proper and efficient handling of claims. The Claims Specialist maintains professional relationships with OTRP members, staff, legal counsel and other service providers necessary for the efficient management of OTRP claims department activities. The Claims Specialist shall, at a minimum, have an Associates' Degree, or Bachelor's Degree. Completion of the Associate in Claims, Certified Insurance Counselor and/or other relevant CPCU designations is preferred. No prior experience is required but a plus. The Claims Specialist shall have the ability to: Communicate verbally and in writing. Act in a self-directed and independent manner. Legally operate a motor vehicle. Physically navigate member and accident sites. Occasionally lift up to 40 pounds (paper, office supplies, etc.) Learn PC's and software applications including word processing, financial management/accounting, spreadsheets, data bases, claims information systems, desktop publishing, e-mail, etc. Understand office terminology, practices, procedures and equipment. Coordinate and develop presentations and conduct training sessions on job specific topics. In addition, the Claims Specialist shall be or shall become skilled/knowledgeable in the following areas: Management of a book of claims. Gain knowledge of coverage issues and technical expertise to support the final disposition of a loss or claim. Negotiation of reasonable settlements in a professional manner Relevant provisions of Ohio law (particularly sovereign immunity statutes). Public transit and insurance/risk management practices. The Claims Specialist is expected to work weekdays between 8 AM and 5 PM. The Claims Specialist will spend approximately 50% of their time in an office environment with the additional 50% divided between walking/navigating, standing, operating a motor vehicle, attending meetings, or doing field investigations off-site. The Claims Specialist must be able to remain stationary for long periods of time; occasionally move about the inside of an office to access filing cabinets, office machinery, and other tasks; constantly operate a computer and other office machinery; share accurate information with clients, claimants, and co-workers both in person and electronically; and occasionally work in outdoor weather conditions. A flexible work schedule may be permitted, subject to the approval of the CEO, provided it can be consistently maintained and meets the needs of OTRP. Requirements to work in excess of a 40-hour workweek will be rare but may include extra hours on weekdays or weekends as circumstances require.
General Duties & Responsibilities:
1. Makes decisions and operates in accordance with established OTRP policies and procedures. 2. Proofreads and independently composes correspondence. 3. Prepares reports, presentations, summaries, and studies as needed or required. 4. Maintains filing system for all claims/litigation (open and closed) and categorizes/indexes same for quick retrieval. 5. Maintains an inventory of all Claims Department Materials. 6. Assists in making contributions to the OTRP newsletter/website, and making periodic reports to the OTRP Board 7. Assists CEO in the development of quarterly Board/Committee packets and attends OTRP Board meetings. 8. Performs other duties as assigned by the CEO.
Specific Duties & Responsibilities:
9. Understands and follows the OTRP Claims Manual and Litigation Management Policy. 10. Works in tandem with Senior Claims Department personnel to complete claims processing activities. 11. Provides member transit systems with information relating to OTRP claims/litigation policies and procedures and answers routine inquiries relating to risk management, safety or insurance. 12. Travels to the scene of accidents/incidents for the purpose of taking photographs, collecting loss-related artifacts/evidence, interviewing witnesses and determining the proximate cause of losses. 13. Maintains complete notes/log of all claims adjusting/investigative work and communications with claimants. 14. Studies and analyzes accident/event reports for the purpose of determining liability. 15. Contacts members, local law enforcement agencies, adverse adjusters, claimants, and attorneys for claim or subrogation information and to establish/confirm investigation facts relating to property and liability claims. 16. Maintains communication on open claims, consulting with members regarding resolution strategies and settlement of claims/litigation. 17. Establishes reserves on all open claims in a timely and accurate manner. 18. Inputs claims information into the claims database system, including all claims reserve and payment information. 19. Establishes a diary system for all open files to ensure timely review. 20. Assists with management of OTRP database, and periodically assists in the audits of the database for integrity and accuracy. 21. Assists in the financial reconciliation of the claims systems. 22. Assists OTRP's auditors with the annual financial audit. 23. Assists OTRP's Claims Auditors with any claims audits. 24. Notifies the Sr. Claims Specialist and/or CEO of serious events which may result in a catastrophic loss or litigation. 25. Receives and pursues recovery of subrogation claims assigned to
OTRP. 26.
Reviews bills presented by outside adjusters, accident investigators and attorneys. 27. Prepares check vouchers for finance to ensure the proper and timely payment of settlements and loss adjustment/legal expenses. 28. Closes claims promptly and appropriately.
Pay:
$48,000.00 - $78,000.00 per year
Benefits:
Dental insurance Health insurance Health savings account Life insurance Paid time off Prescription drug insurance Retirement plan
