Senior claims adjuster job description

We're excited you're considering joining a great place to work!
Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law.
About this Position
As an adjuster, you will conduct claim investigations and administer benefits to injured workers and/or their beneficiaries in accordance with the Texas Workers' Compensation Act, rules of the Division of Workers' Compensation (DWC), and internal policies and procedures. You will work under general supervision and report to the Supervisor of Claims. You will also enjoy two work-from-home days on Monday and Friday each week and have the option of a flexible M-F work schedule within primary business hours. In addition, you will enjoy the opportunity to work remote up to ten days per year from anywhere in the U.S.

Responsibilities & Qualifications
What you can expect as an adjuster:
You will administer workers' compensation benefits to injured workers.Conduct investigations for coverage and compensability, establish and maintain appropriate reserves, and make appropriate recommendations on claims.Manage established claims on an ongoing basis.Ensure regulatory compliance and proper handling of claims.Demonstrate a high level of proficiency in claim file management, work effectiveness, interpersonal skills and customer service.

What you need to be successful as an adjuster:
Bachelor's degree or equivalent education, training, or experience.A range of 4 - 6 years of experience adjusting workers' compensations claims required for Senior Level. Or equivalent education, training, or experience for all levels.Current Texas workers' compensation or all lines adjuster license.

Flex-Hybrid Work Environment:

Texas Mutual's flex-hybrid schedule allows you to bring your best self to work by either working remotely or collaborating in the office based on business needs. All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed.

Our Benefits:
Flex-hybrid work environment for most positions Annual performance bonus and merit-based pay increase Professional development and tuition reimbursement Automatic 4% employer contribution to retirement plan 401k plan with 100% employer match up to 6%Three weeks' time off for vacation Nine paid holidays and two personal days each year Generous sick, holiday and volunteer time off Day one health, Rx, vision and dental insurance Life and disability insurance Flexible spending account Pet coverage and pet Rx discounts Free on-site gym, fitness classes, and health and wellness resources Free identity theft protection Free 2nd medical opinion service Free student loan repayment and refinancing consultation Employee referral bonus

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.
Essential Functions:

Investigates casualty claims of moderate to severe complexity, including claims in litigation Experience handling underinsured motorist (UIM) and uninsured (UM) motorist claims and UIM/UM litigation Reviews the claim notice and policy to verify coverage, deductibles, claim payee/mortgagees and confirms that the claim date falls within the coverage period Initiates contact with insureds and claimants to obtain information on the claim and provide information on claim process Takes statements from insureds/claimants/witnesses Documents claim files Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology Resolves questions of coverage, liability and the value of claims Secures the necessary official reports, claim forms and documents Reviews bills, invoices and receipts for accuracy Provides prompt, detailed responses to agents, insureds and claimants on the status of claims Identifies opportunities for recovery and investigates and pursues accordingly Negotiates, settles and/or resolves claims Assists in suits, mediations and arbitrations Communicates with other departments to submit referrals or share risk reports

Education & Experience:
Bachelor's degree or equivalent work experience Six years of claims adjusting experience Insurance designations preferred

Knowledge, Skills & Abilities:
Proven, excellent knowledge of the theory and practice of the claim function Analytical ability and sound judgment with respect to liability and coverage Strong knowledge of insurance contracts, medical terminology and legal aspects of court procedures High standards of professional conduct Strong knowledge of computers and claims systems Strong organizational and written and verbal communication skills Excellent investigative and problem-solving abilities Travel required; a valid driver's license with an acceptable motor vehicle report per company standards required if traveling

Our employment practices are in accord with the laws which prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.

To learn more about why you're gonna love it here, watch the video below.

About Falcon
At Falcon Insurance Company (“Falcon”), we prioritize meaningful careers! Falcon is a property and casualty insurance company specializing in non‐ standard automobile insurance and related products and services. Falcon is a growing company who currently write in Texas, Illinois, Oklahoma, Indiana, Arizona, Colorado, and Utah with high expansion expectations. Falcon is led by a strong management team with over 75 years of non‐standard automobile insurance experience.
What’s in it for you?
We offer competitive benefits, 401(k) match, generous referral bonus, paid time-off (PTO), and pay with a potential for an annual financial bonus based on both individual and company performance. Our employees have the opportunity to participate in volunteer events, company outings, summer happy hours, and holiday events! We offer programs to assist with paid training and licensing, professional learning development, career development reimbursement, wellness incentives, and so much more!
At Falcon, it’s not the company that makes the people; it’s the people that make the company. Visit our Careers page at www.falconinsgroup.com for more information on our benefits, locations and learn how to join our growing team!


Responsibilities
Do you enjoy helping others through problem-solving and thrive in a fast-paced environment?
A day in the life of a HYBRID Claims Adjuster - Level II:

• Plan and manage claim investigations, primarily handling physical damage claims in Texas and Illinois, including interviewing all involved parties through detailed recorded telephone statements, collecting/evaluating documentation, securing evidence and conducting thorough searches using known industry databases.
• Analyze obtained documentation and evidence, evaluate coverage, determine liability and extent of damages
• Effectively document records, update status notes, results of external information gathering and other relevant reports
• Process payment of claims

Qualifications



You’re a great match for this role if:

• You have 2-5 years’ experience handling non-standard automobile lines
• You reside in the following states: IL, TX, or AZ
• You have previous experience handling policy coverage, claim investigation, and negligence laws
• You’re organized and able to multi-task in a fast-paced and high call volume environment
• You’re a self-starter who can work as part of a team and independently
• You have an active Texas license (preferred)
• You are bilingual (preferred)
• You have a degree in Business, Criminology, Political Science, Sociology, or Psychology (preferred)

Flexible work from home options available.