Senior Claim Adjust

A. Purpose of Position
To provide quality, cost efficient and timely investigation and adjustment of commercial claims to
which they have been assigned, while delivering the highest level of customer service to our
policyholders, agents and claimants.
B. Principal Duties and Responsibilities (List major duties in descending order)
Under general supervision, is responsible for the timely and effective handling of assigned claims
from a multi-state jurisdiction. This includes receiving new Notices of Loss from supervisor or
manager, handling and directing existing cases and other claims which have been transferred from
other adjusters. Maintains an inventory of claims handled within departmental guidelines, following
the Best Practices policies and procedures as established for claims adjustment and following
established budgetary guidelines.
Under supervision, investigates & handles claims (included but not limited to a variety of claims such
as Commercial Auto, CGL, Property or Workers Compensation). Under supervision, negotiates
limited settlements, setting reserves and interprets coverage. Has settlement authority and specific
amount will by assigned by Manager.
Attends mediations for those cases within authority and any other duties related to the effective
handling of claims. Implements strategies to expeditiously close files and manages claims to a
conclusion in the most effective manner possible.
With final approval of manager, is responsible for comprehensive reporting on the status of claims.
This includes the preparation and presentation of reports and summaries to claims management staff
as well as certain classes of policyholders and independent agents.
With general supervision, works with and oversees the work of independent adjusters and
miscellaneous vendors. This includes working closely with vendors in an attempt to handle claims
effectively and contain expenses. Is responsible for delivering the highest level of customer service.
This includes adherence to company established guidelines for timely contact and following company
guidelines on telephone etiquette and responsiveness.
Provides all of the necessary benefits under statutory rules, regulations and guidelines as applicable.
Documents all file activity including but not limited to phone calls, attorney contact, medical providers,
etc. Documents a plan of action, strategy and future exposure. Sets and maintains an appropriate
diary schedule as specified in our claims company guidelines.
Follows through on supervisor's instructions and adheres to company policies and procedures, at
both the departmental and company level.
Exhibits understanding of C.O.R.E. competencies, and the relevance of essential and functional skills
to the performance of the job. Actively pursues audio and/or readings, self-study courses, in-house

and company-sponsored courses and seminars in order to achieve or exceed established C.O.R.E.
competencies and Smart Goals. Focuses on individual development as relevant to job functions.
Operates keyboard devices effectively.
Performs other duties and responsibilities as assigned.
C. Knowledge or Specialized Knowledge Required for Performance of the Work (What you
must know in order to perform this job)
Advanced knowledge of insurance claim procedures, rules, systems, and regulations.
Advanced knowledge of claim file management techniques and processes.
Strong understanding of the judicial and legal systems.
Good knowledge of medical terminology.
Proficient with personal computers.
D. Specific Skills and Abilities Preferred or Required for Performance of the Work
(Proficiencies necessary to perform this job)
Excellent communication, interpersonal and organizational skills.
Ability to analyze, define and solve problems; the use of good judgment and decision-making.
Ability to interpret and explain insurance policy coverage as applicable to the area of claims handling.
Excel in FCCI’s Core Competencies with specific focus on:
Continuous Learning
Creative Problem Solving
Customer Focus
Teamwork & Relationship Building
Business & Professional Knowledge
Planning & Organizing
Embraces Change
E. Business Impact (detail decision authority/frequency; quantity job requirements)
Impact resulting in increased customer satisfaction/dissatisfaction, efficiencies/delays in operations
and/or financial gains/losses with short-term impact.
F. Major Challenges: (Describe a few of the major challenges involved in achieving the job’s basic
Will be expected to investigate and handle claims to an equitable conclusion with limited supervision.
Must recognize the potential for large exposures.
G. What level of innovative or creative thought is most often required in this job?
Improve current methods, products, services or technology.
H. Supervisory Responsibilities

I. Supervision Received (Title of immediate supervisor & nature of guidance)
General supervision received from Claims manager/director.
J. Physical Demands/Work Environment (Describe the nature of physical activity involved and any
unusual environmental conditions).
Work requires primarily office and some limited fieldwork. May be required to do some fieldwork
based on the complexity of a given case and the geographic region of the loss. Valid driver’s license
preferred. Some overnight travel could be required as a result of attending mediations, arbitration’s,
claim investigations and/or training purposes.
K. Personnel Contacts and Purpose of Contacts (Describe the normal types of contacts with
persons other than those in the supervisory chain and the purpose of the contacts)
Contact with claimants, clients, policyholders, agents, vendors, as well as with staff of various FCCI
Insurance Group departments to negotiate, advise and exchange information.
L. Changes (What demonstrable changes in duties have been added or taken away from
this position since last completed)
Grade changed to Gr. 14 December 2015.
M. Minimum Qualifications (Experience and Education necessary to perform this work)
High School Diploma or equivalent
Four years adjusting experience in the applicable insurance area. Demonstrated competencies in
handling more complex claims.
Applicable adjuster license required; must obtain additional licenses within 6 months of hire.
NOTE: Relevant, progressively responsible work experience may be substituted on a year for year
basis for the required education
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Job Locations




6114 La Salle Avenue, Suite 120
Oakland, CA 94611
(415) 857-2304