Job Description

Job Description As a Claims Adjuster – Technical Adjudication, you will handle and adjudicate complex insurance claims, ensuring fair and accurate claim resolutions in compliance with company policies, regulatory requirements, and service standards. You will be responsible for managing end-to-end claims processes, investigating claim facts, determining coverage, assessing liability, negotiating settlements, and maintaining strong relationships with members while delivering on commitment to service excellence. Key Responsibilities Review, analyze, and adjudicate assigned claims (auto, property, casualty, or specialty lines) with technical accuracy and efficiency. Evaluate coverage, liability, and damages to determine appropriate claim outcomes. Investigate claims through interviews, document review, and coordination with third-party vendors or field adjusters. Ensure claims decisions comply with state regulations, guidelines, and best practices. Negotiate settlements and manage reserve and payment authority within company limits. Maintain detailed documentation of claim activities and communications. Identify potential fraud indicators and refer as appropriate. Collaborate with internal partners (legal, underwriting, SIU, etc.) to ensure comprehensive resolution. Support process improvement initiatives and mentor junior adjusters as needed. Required Skills & Qualifications Bachelor’s degree or equivalent experience. 3+ years of hands‑on experience in claims adjudication (property, auto, casualty, or life/health). Proven technical expertise in evaluating policy coverage and applying claims‑handling procedures. Strong analytical and problem‑solving skills with attention to detail. Excellent communication, negotiation, and decision‑making abilities. Familiarity with claims management systems (e.g., Guidewire, ClaimCenter). Ability to interpret and apply insurance laws, regulations, and policy language. Strong time management and organizational skills. Ability to work independently while meeting production and quality goals. Preferred Skills Professional certifications such as CPCU, AIC, or SCLA. Experience with complex or catastrophic losses. Knowledge of military member insurance needs. Prior experience working in a regulated claims environment. Seniority Level Mid‑Senior level Employment Type Contract Job Function Administrative #J-18808-Ljbffr

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