Injury Examiner

• Adjusts complex auto and homeowner bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims.


• Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.


• Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates.


• Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation.


• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.


• Serves as a resource for team members on complex claims.


• Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication.


• Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.


• May be assigned CAT deployment travel with minimal notice during designated CATs.


• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.


• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

• High School Diploma or General Equivalency Diploma.


• Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.


• Advanced negotiation, investigation, communication, and conflict resolution skills.


• Demonstrated strong time-management and decision-making skills.


• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.


• Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims.


• Ability to exercise sound financial judgment and discretion in handling insurance claims.


• Advanced knowledge of coverage evaluation, loss assessment, and loss reserving.


• Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.

• Experience handling UM/UIM injury claims.


• 2+ years of catastrophic injury experience.


• College Degree (Bachelor's or higher).


• Insurance Designation.