Claim adjuster II

Posted:
10/29/2024, 1:49:24 PM

Location(s):
North Carolina, United States

Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior

Field(s):
Legal & Compliance

Workplace Type:
Remote

We’re thrilled that you are interested in joining us here at the Amynta Group!

To provide the effective adjustment of Ambridge claims. Communicating with clients, collaborating with underwriters on claims issues when appropriate and effectively liaising with brokers and third parties in the adjustment of claims, consistent with company strategy and regulatory and legal compliance.

Claims Intake and Triage

Assist in registering new claims in Ambridge internal system on behalf of claims team including review, acknowledgment, and assignment of claims.

Review claims and determine appropriate open or close status.
Technical Claims Handling

Operate within your approved claims authority at all times.

Adhere to Ambridge Claims Guidelines, binding authority and service level agreements provided by business partners/capacity providers and Lloyd’s Minimum Standards for Claims Management, with deviations occurring only with prior authorization by the relevant Head of Claims, Head of Operations Group Claims, or the Group Head of Claims.

Ensure claims are being set up timely, accurately, and acknowledged according to claims guidelines.

Ensure claims are handled in accordance with local law/jurisdiction.

Ensure strong working knowledge of Ambridge policy forms and understand underwriting intent.

Adequately gather and analyze sufficient information to make an appropriate liability decision.

Ensure that potential recoveries from third parties are investigated and pursued.

Ensure reserves for outstanding claims are set on a timely basis and based on best efforts and estimates, the appreciable facts and information available at the time and the likely outcome of the claim.
Ensure that documentation is consistently contained in the file and adequately supports the loss and expense payments made.
Strategic Claims Handling

Properly monitor defense counsel, including the quality and timeliness of reports and appropriateness of defense strategy.

Develop a pathway to resolution, obtain necessary settlement authority and effectively pursue settlement opportunities.
Third Party Management

Ensure TPA’s for which you have oversight responsibility adhere to applicable Claims Guidelines
and Lloyd’s Minimum Standards.

Ensure assigned TPA’s consistently satisfy reporting requirements.

Continually evaluate the performance of assigned client SIR and BGS-selected TPA’s and take
action where appropriate.
Collaboration with Underwriters

Provide feedback to underwriting on claims trends, development and impact on their book.

Suggest product/contract wording changes to avoid future losses based on prior experience.
Continuous Learning

Participate in Peer Reviews as both a reviewer and reviewee.

Maintain up to date expertise in claim handling, by among other things, reviewing recent case law, attending seminars and keeping abreast of any regulatory developments.

Participate, as needed, in interviewing, hiring, training, and development of additional staff. Decision Making Responsibilities:

Review new claim submissions and determine open/close status and assignment of claims.

Recommendation of improvements to the claims processes and procedures.

Effective, independent, decision making and problem solving when dealing with technical claims scenarios.

Appointment of approved independent experts as appropriate.

Ability to analyze specialized external reports and recommend appropriate courses of action.

Make judgements and tailor existing practices to new and emerging situations to offer effective solutions. Regulatory Conduct Rules

Act with integrity.

Act with due skill, care, and diligence.

Be open and co-operative with Lloyd’s and other regulators.

Pay due regard to the interests of customers and treat them fairly.

Observe proper standards of market conduct.
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Education, Qualifications, Knowledge, Skills and Experience:

4-year college degree preferable.

3-5 years adjusting experience with ability to handle coverage issues and mid exposure claims.

A commitment to continuous personal and professional development.

Knowledge and understanding of product features, benefits, exclusions and warranties and application to various situations.

Understandings of the legal principles giving rise to subrogation.

Basic knowledge of principles of risk management.

Effective prioritization and organizational skills in order to meet timescales.

Advanced literacy and numeric skills.

Excellent interpersonal and communication skills.

Advanced IT skills, including Microsoft Office with the ability to learn new systems.

Excellent persuasion, influencing and negotiation skills.

The Amynta Group (the “Company”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal employment opportunity. The Company will accommodate a candidate to the point of undue hardship. Please inform the Company's personnel representative if you require any accommodation in the application process.