[Hiring] TPA - Tier 3 Claim Owner @Farmers Insurance

Role Description

This position handles Tier 3 California mid-loss auto policy claims requiring in-depth claim investigation, coverage confirmation, damage assessment, liability determination, and settlement negotiation. The role owns the entire claim process and serves as the primary point of contact to facilitate claim resolution. This position uses in-depth expertise to manage claim scenarios such as multi-vehicle auto losses with comparative negligence and bodily injury losses pertaining to soft tissue injury, fracture, dislocation, ligament injury, herniated disc and nerve injuries. In addition to claim issues handled at lower tier levels, this position investigates coverage issues requiring in-depth investigation, policy interpretation, and knowledge of state statutes and case law such as those with applicable exclusions or endorsements. Works within prescribed authority to proactively and accurately resolve claims. Escalates claims with exposures exceeding financial authority or Tier 3 complexity to supervisor.

• Candidate must reside in PST, CST, or MST. Will consider EST, however candidate must be willing to work until 3 PM PST.

Essential Job Functions

• Evaluates bodily injury claims promptly including assessment of medical and general damages and wage loss.
• Analyzes injury causation for all alleged injuries.
• Evaluates, sets, and updates case reserve amount for injury exposures throughout the life of the claim.
• Negotiates settlement of bodily injury claims with unrepresented claimants and with represented claimants' attorneys.
• Recognizes and investigates all potential claim exposures, including injury exposures.
• Conducts investigations by obtaining recorded statements of involved parties.
• Collects police reports, vehicle photos, scene inspections, signed medical authorizations, medical bills and medical records, and other supporting evidence.
• May conduct in-person or virtual meetings with customers based on claim needs.
• Analyzes duties owed and breached by all potential responsible parties and determines liability percentage for each party.
• Communicates liability decisions to stakeholders including customers, claimants, claim specialists, and Underwriting.
• Recognizes subrogation potential and makes referrals to Subrogation department when appropriate.
• Communicates policy risk issues to Underwriting to facilitate evaluation of policy risk and exposure.
• Conducts material misrepresentation investigations and submits findings to Underwriting; maintains active diary and resolution plan on open claim files.
• Handles and documents claim files in compliance with regulatory requirements.
• Authorizes and issues claim payments to customers, repair facilities, rental vendors, and others.
• Obtains signed release of claims and issues payment upon final settlement.
• Provides professional verbal and written communication to customers including claim status updates, coverage explanations and decisions, and correspondence, including Reservation of Rights and Disclaimer letters, within prescribed authority limits.
• Communicates with insured throughout the claim process to keep them informed; comprehensively assesses policy details to confirm coverage.
• Makes same-day contact with customers to explain the claim process and verify facts of loss.
• Explains coverage details to policyholders; determines vehicle location and condition.
• Secures timely auto physical damage estimates via proper inspection method and repair channel.
• Explains repair process and estimates to customers and offers repair and rental service options.
• Proactively manages and mitigates storage costs and arranges release of vehicles accruing storage fees.
• Coordinates with auto physical damage and total loss specialists to facilitate claim resolution.
• Mentors Tier 3 Claim Owner I level.
• Performs other duties as assigned.

Physical Actions

• Sits or stands for extended periods of time, up to a full work shift.
• Occasionally reaches overhead and below the knees, including bending, twisting, pulling, and stooping.
• Occasionally moves, lifts, carries, and places objects and supplies weighing 0-10 pounds without assistance.
• Listens to, interprets, and differentiates auditory information (e.g. others speaking) at normal speaking levels with or without correction.
• Visually verifies and reads information; visually locates material, resources and other objects.
• Ability to continuously operate a computer for extended periods of time, up to a full work shift.
• Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate keyboard and other office equipment up to a full work shift.

Qualifications

• High School Diploma or equivalent required.
• Bachelor's degree preferred.
• Completion of, or actively pursuing a major insurance designation, or actively pursuing insurance related courses.

Experience Requirements

• 1-3 years of experience in claims adjusting or related field required.
• Injury experience is preferred.

Benefits

• Farmers offers a competitive salary commensurate with experience, qualifications and location.
• CA Only: $70,304 - $110,000
• CO & ME: $60,750 - $95,150
• HI/IL/MN/VT Only: $60,750 - $101,750
• MA Only: $60,750 - $101,750
• MD & VA: $60,750 - $101,750
• DC/NJ/NY/OH Only: $62,353 - $110,000
• Albany County, NY/Cleveland, OH: $64,875 - $95,150
• WA Only: $80,168 - $115,625
• Bonus Opportunity (based on Company and Individual Performance)
• 401(k)
• Medical
• Dental
• Vision
• Health Savings and Flexible Spending Accounts
• Life Insurance
• Paid Time Off
• Paid Parental Leave
• Tuition Assistance