Job Description
This position resides in the Third Party Administration department, with Thomas McGee Group, a division of Risk Strategies, and provides full client solutions including employee benefits, surety, commercial insurance and Personal insurance along with our TPA services. Thomas McGee Group was founded in 1910 and provides practical solutions for our clients. Thomas McGee Group's mission is to "Serve First": Serve our clients, our community and our associates.
The Claim Adjuster provides various functions in the management of claims administered by the Risk Management department:
Primary Responsibilities and Duties:
- Serves as a dedicated resource to Risk Management customers for handling and communication of workers' compensation and/or property and casualty claims
- Serves as a designated Adjuster as part of the service team for specific accounts
- Makes contacts, investigates questionable losses, documents facts surrounding the incident, to include decision regarding liability/compensability, as well as action plan and reserve rationale
- Uses outside vendors to determine damages or mitigate exposures, use of vendors who assist with coordination of medical treatment and return to work, and use of defense counsel on litigated claims may be necessary
- Identifies and pursues fraudulent claims
- Investigates potential subrogation and pursues third-party continuing through the recovery process
- Works directly with Claim Technician to assure mail is addressed, bills are paid and customers' questions are answered quickly and appropriately
- Uses strong diary system to ensure timely follow up and monitors treatment, receipt of bills or records, reserve adequacy, negotiation of settlement, payment and closure
- Uses cost containment strategies in daily activities to include direction to PPO networks, close monitoring of investigators and aggressive litigation management
- Maintains a strong back-up process with the other Adjuster on the team, and with the Claim Technician to assure consistent service during absences of any member of the team
- Makes sure the team is functioning at a high level at all times, to include providing feedback on performance of Claim Technician to the Manager, Risk Management Claims
Requirements and Qualifications:
- Bachelor's degree from an accredited four-year college or university, or equivalent experience preferred
- Strong organizational skills
- Ability to apply mathematical concepts
- Ability to work successfully in a deadline driven environment
- Working knowledge of Microsoft products (Word, Excel, Outlook, etc.)
Working knowledge and comfort level with claims management systems; and comfort working in a paperless environment
Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, the firm serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and 5,000 employees across the US and Canada.
Industry recognition includes being named a Best Places to Work in Insurance for five consecutive years (2018-2022) and to the Inc. 5000 list as one of America's Fastest Growing Private Companies. Risk Strategies is committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues.
Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: Risk Strategies
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