Casualty Claims Adjuster

Company:
Everest Insurance (Ireland) France

Job Category:
Claims

**Job Description**:
Everest is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in the Europe, Bermuda, Canada, Singapore, US, and other territories. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. But the most critical asset in this organization is our people.

Everest is a growth company offering Property, Casualty, and specialty products among others, through its various operating subsidiaries located in key markets around the world. Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.

**Role Purpose**:
To provide effective multidisciplinary claims handling in accordance with the Claims Department’s guidelines and procedures. The Claims Adjuster will investigate and evaluate Third Party claims, with special focus on Casualty line of business. They will participate in all aspects of a claim file, including data gathering, investigation, development of claims summaries and timelines and vendor assignment.

In addition, the Adjuster will prepare and maintain appropriate documentation and claims reports in applicable databases and information systems. They will act as a contract owner of certain TPAs monitoring their performance and communicating updated claims information to customer and brokers, as directed.

**Key Accountabilities**:

- Assists with and/or directly handles all aspects of a claim file from beginning to conclusion, including the investigation, determination of liability, confirmation of coverage, assessment of damages, and drafting of claim evaluation for recommended action.
- Investigates claims, obtains appropriate data, and assembles appropriate information and facts regarding claims, including evaluation of clinical charts, interviewing healthcare providers, securing internal reviews, and developing case summaries and timelines.
- Utilizes litigation management and claims management information systems to maintain, organize, and retain relevant claims data and files.
- Reviews all claims for status of investigation, assessment of liability, documentation of damages, adequacy of reserves, evaluation of expert witnesses, documentation of recent developments and current plan for claim resolution within Everest´s Best Practices.
- Manages relationships and provides support for internal and external customers, serving as a primary source of contact and support for individuals named and/or involved in claims and lawsuits.
- Maintains collaborative working relationships with other departments and entities to facilitate quick responses to internal and external customers.
- Participates in problem solving and problem resolution, in accordance with Company policy, guidelines and statutes, and regulatory agency requirements.
- Identifies trends and opportunities in the areas of handling and participates in reporting and communication, as directed.
- May assist with efforts to educate clients and brokers regarding risk issues identified through claims data to mitigate future liabilities.
- Performs miscellaneous job-related duties as assigned including onboarding and monitoring TPAs and vendors´ performance and provide support, input and conduct system testing when required.
- Conduct salvage, subrogation, or other recovery proceedings through close monitoring. Investigate Fraud and ensure timely advices, relevant supporting documents and responses to enquiries are provided to coinsurers/reinsurers to settle their share promptly.
- At least 7 years’ experience, directly related to the duties and responsibilities.
- Experience in managing Casualty claims is essential. Experience in other third party lines of business (Financial Lines, Medmal) is desirable.
- Fluent level of French and English languages, both written and spoken are essential.
- Strong investigative and problem resolution skills.
- Bachelor's degree in law is preferred.
- Strong interpersonal skills and the ability to work effectively with a wide range of constituencies in a diverse community and excellent customer service.
- Ability to organize work effectively and methodically. Highly adaptable to change in a fast-paced environment.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to develop and maintain record-keeping systems and procedures.
- Knowledge of the French judicial system and procedures.
- Knowledge of principles, procedures, and standards to esc