ADR Claims Assistant Director

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SUMMARY

The Alternative Dispute Resolution Claims Assistant Director (ADR AD) is responsible for the oversight of claims involving Notice of Intent to Litigate (NOITL), Alternative Dispute Resolution requests and/or demands, Civil Remedy Notices (CRNs) and other pre-suit claims as assigned.

DAILY JOB DUTIES:

• Review and assign incoming NOITL and CRNs received from the Department of Financial Services (DFS), as well as ADR requests and/or demands.
• Strategize with the assigned director, manager and/or adjuster to achieve appropriate outcome for each disputed claim file.
• Develop and implement negotiation strategies, where appropriate.
• Identify and appropriately position claims with coverage questions, where appropriate.
• Select, retain, and direct appropriate defense counsel where needed.
• Collaboratively communicate with defense counsel on industry trends or case law/statutory developments that may impact operation.
• Maintain up to date knowledge of legislation, regulations, and industry events which pertain to insurance claims.
• Provide leadership to all team members and regularly conduct effective and timely structured Performance Feedback sessions.
• Develop and implement training for Claims employees, collaborating with the Training & Auditing department where necessary.

• Perform other duties, as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Reviews detail of claims under applicable policy for first-party property losses to determine insurance coverage, effective dates, policy limits and exclusions. Identifies, monitors and resolves coverage issues, with assigned manager and/or adjuster.
• Reviews and assigns claims to the appropriate adjuster as determined by the details of the claim as reported or when file transfer request is received.
• Directs and controls the establishment of appropriate claim reserves to ensure that future claim costs are accurately assessed, and the company can determine its financial position.
• Directs and manages managers’ and desk adjusters’ activities.
• Reviews examiners’ and experts’ reports for accuracy and determines details of loss and coverage.

• Compares loss claimed to policy coverage and refers claims to the director of claims if loss exceeds managers authority levels.

• Reviews the file with assigned manger and/or adjuster inclusive of estimates of costs of repair, replacement or compensation. Reviews and approves reserves in accordance with Frontline guidelines.

• Requests additional authority level from the director of claims on a per file basis as required to fairly settle the claim if over the manager’s authority.
• Directs and manages complex adjuster to appropriately continue the investigation utilizing all available technologies to further investigate, document and resolve losses and coverage issues that were unable to be resolved within the daily unit.
• Interfaces with company clients, carrier, adjusters, or covered parties. Communicates with agents regarding status of claim.
• Assists adjusters as needed for proper resolution of claim. Calculates settlement or payment and communicates with client, adjuster and customer. Authorizes payment or settlement of claims within provided guidelines or seeks authority from the carrier. Reviews, approves or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
• Resolves disputes regarding claims resolution. May reopen and re-evaluate claim, if necessary.
• Monitors performance, reviews open and closed claims to ensure claims have been properly handled and moved towards resolution in a timely manner.
• Acts as an expert resource to others in the claims department regarding coverage issues, reserves, exposure, settlement value, and strategy.
• Responsible for assisting with staffing of the claims department with qualified employees.
• Conducts performance reviews and administers disciplinary measures, when required.
• Provides training to and development of adjusters
• Submits monthly management reports and prepares special reports when requested.
• Participates in special projects or tasks as required.
• Responds to inquiries from various state entities
• Responds to inquiries from other departments regarding claim handling, processing and coverage issues.
• Assists in the conducting of audits of vendors, primary and independent adjusters.
• Participates in litigation when applicable.

EDUCATION and/or EXPERIENCE

Successful candidates will have a minimum of ten years of experience handling, supervising and/or directing first-party party property claims including a minimum of five years of experience as carrier staff management handling Florida homeowner property claims. Legal experience handling first-party property claims is preferred.

• College degree and/or equivalent insurance designations.
• Adjuster licenses are required for all states where Frontline currently conducts business, as is the ability to obtain licenses in other states where Frontline conducts future business.
• Strong personal lines coverage interpretation and claim handling background is required.

• Residential construction knowledge and be proficiency in Xactimate preferred
• Possess a valid driver’s license.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Must also be able to deal with problems involving several concrete variables in standardized situations.

LANGUAGE SKILLS

Must possess the ability to read and comprehend detailed instructions, correspondence, and memos as well as write simple correspondence. Must also be able to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

MATHEMATICAL SKILLS

Must be proficient with the following: addition, subtraction, multiplication, and division in all units of measure, using whole numbers, common fractions, and decimals.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

NOTE: This is not necessarily an exhaustive list of responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, Frontline Insurance reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed when circumstances change.

I have carefully read and understand the contents of this job description. I understand the responsibilities and duties expected of me. I also understand that this job description does not constitute a contract of employment nor alter my status as an at will employee. I have the right to terminate my employment at any time and for any reason and Frontline Insurance has a similar right.