Under moderate management, supervises a team of claims adjusters. Actively drives adjuster hiring and leads adjuster training. Actively manages assigned adjuster workloads and performance. Participates in compliance and best practice reporting. Demonstrates a thorough understanding of corporate policies and procedures.Essential Duties & Responsibilities:Uses various metric driven tools such as FOCUS, the Claim Operation Tool Kit to evaluate performance and identify problem areas in advance of them becoming service issues.Reviews findings with manager to jointly develop a plan for corrective action..Defines team goals and communicates those goals to assigned staff. Motivates people to perform at the highest level.Ensures receipt and maintenance of appropriate licenses and/or certifications for themselves and all assigned staff for all states in which states are being handled.Communicates with clients, carriers and brokers in a professional, positive and proactive manner.Works collaboratively across all internal departments.

Review, assign and provide supervision of all claim activity for designated claims to ensure compliance with Corporate Claim Standards, client specific handling instructions and in accordance with applicable laws.Investigate, evaluate and adjust assigned claims in accordance with established claim handling standards and laws.Reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.Provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.Assist designated claim staff in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)Direct handling of designated litigated and complex claims.Provide education, training and assist in the development of claim staff.Review and maintain personal diary on claim system.Supervision of all claim activity for specified accounts.Compliance with Corporate Claim Handling Standards and special client handling instructions as established.Performs other duties as assigned.

Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Models ethical behavior and executes job responsibilities in accordance with Gallagher Basset's Best practices, core values, ethics, and information protection policies.Review lawsuits and claim files and provide recommendations for the handling of new law suits.Have the technical knowledge of estimating and repair methods and the ability to review and compare estimates for overlap, pricing, understand industry standards and repair options and assess the potential effect on jury views and trial outcomes.Recognizes the potential deficiencies in a case and the need to a negotiate settlement as a potential resolution.Assists management with the creation of strategic initiatives and the implementation of litigation strategies.Ability to interpret policy language and recognize potential ambiguities that could lead to potential adverse verdicts.Ability to adapt to change and work efficiently to provide prompt review and assessment of potential trial outcomes.Ability to research internal and external websites.

Licensed in 22 States (Including Florida) to Handle complex and litigated Commercial General Liability claims including Slip & Falls, Premise Liability, Construction Defect, Commercial Auto Liability and Bodily Injury files throughout the United States. Specializes in prompt resolution of claims up to $1 million and beyond with extensive discretionary authority per feature. Receive, investigate and successfully resolve customer claims Follow-up on all new cases to communicate with involved parties and resolve. Coordinate with other departments to investigate claims, obtain documentation and oversee successful safety programs to reduce guest related claims. Maintain close contact with plaintiff and defense counsel and demonstrate an ability to reduce claims litigation, improve claims resolution and the defense of customer claims. Work with insurance carriers and agencies. Run ISO reports when applicable Prep files for mediations, present with defense counsel and VP of Claims as necessary Attend hearings, mediations and trials utilizing proprietary defensible AMTRUIST programs Obtain, review and evaluate medical information on claimant's to make sure treatment is casually related to the claim. Present files in round table format to obtain settlement authority and Negotiate settlements. Assist in preparation for hearings and or appeals with our defense counsel Identify possible subrogation opportunities, place responsible party on notice, follow-up and document any recoveries. Coordinate scheduling of depositions of parties to the litigation and notify staff of key litigation dates Coordinate and assist with investigations of questionable claims in the event of a pre-existing condition and/or fraud. Write up settlement evaluations for all litigated cases. Gather and report on data, industry patterns, and insurance related topics

Managed the company's exposure to risks by ensuring claims made against it and its clients are thoroughly examined, investigated and resolved to minimize financial loss and diminished reputation. Handled a caseload of approximately 150 pending claims that encompass all levels of complexity. Required to establish facts of loss, coverage analysis, investigation, liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud and appropriate use of authorized vendors. Also includes timely and appropriate reserve analysis and report completion. Ability to attend mediation, roundtable presentations to senior level management, conferences, client meetings, mentor other adjusters and assist management as requested. All file handling must be within state statutes, Client Claims Handling Guidelines and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.

Managed a case load of 220+ attorney represented injury claims of various degrees of exposure and complexity. Required to establish facts of loss, coverage analysis, investigation, liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud and appropriate use of authorized vendors. Also includes timely and appropriate reserve analysis and report completion. Ability to attend mediations, conferences, client meetings, mentor other adjusters and assist management as requested. All file handling must be within state statutes, Client Claims Handling Guidelines and Progressive Insurance Company's Best Practices.

Ensured timely, high quality investigations while fostering a high performance work environment. Responsible for fraud detection and deterrence, utilizing appropriate investigative techniques and strategies in all lines of insurance. Required to establish facts of loss, coverage analysis, investigation, liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud and appropriate use of authorized vendors. Also includes timely and appropriate reserve analysis and report completion. Ability to attend mediations, conferences, client meetings, mentor other adjusters and assist management as requested. All file handling must be within state statutes, Client Claims Handling Guidelines and State Farm Insurance Company's Best Practices. Participated with senior staff in the corporate claims strategic initiative micro-test to help re-establish best practices within an ever changing claims industry. The scope of this initiative impacted our entire claims department.

Accomplished manufacturing staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; initiating, coordinating, and enforcing systems, policies, and procedures.Maintained staff by recruiting, selecting, orienting, and training employees; developing personal growth opportunities.Maintained work flow by monitoring steps of the process; setting processing variables; observing control points and equipment; monitoring personnel and resources; studying methods; implementing cost reductions; developing reporting procedures and systems; facilitating corrections to malfunctions within process control points; initiating and fostering a spirit of cooperation within and between departments.Completed production plan by scheduling and assigning personnel; accomplishing work results; establishing priorities; monitoring progress; revising schedules; resolving problems; reporting results of the processing flow on shift production summaries.Maintained quality service by establishing and enforcing organization standards.Ensured operation of equipment by calling for repairs; evaluating new equipment and techniques.Provides manufacturing information by compiling, initiating, sorting, and analyzing production performance records and data; answering questions and responding to requests.Maintained safe and clean work environment by educating and directing personnel on the use of all control points, equipment, and resources; maintaining compliance with established policies and procedures.Resolved personnel problems by analyzing data; investigating issues; identifying solutions; recommending action.Contributed to team effort by accomplishing related results as needed.