Claims Adjuster - Industrial Disease

New Role: Claims Adjuster | Industrial Disease
Insurer
London / Birmingham / Worthing

I am currently partnered with a leading Insurer who are seeking a Claims Adjuster to join their Disease team to focus on NIHL Claims.

This role will be adjusting NIHL Claims arising from the UK, from notice to settlement

My client is looking for someone with a strong understanding of NIHL cases, and this can be from an Insurer/Paralegal/Fee Earner type of role.

Key Responsibilities

• Maintain and update claim files by accurately recording and managing claims data in line with industry best practices, handling matters of significant technical complexity and exposure.
• Exercise sound judgement in verifying policy coverage by analysing relevant terms and determining whether reported losses fall within coverage.
• Assess liability by gathering and evaluating relevant facts, applying applicable laws, and establishing principles of negligence or breach of duty where appropriate.
• Drive timely claim resolution by developing and executing a clear case strategy, completing thorough evaluations, and escalating issues when necessary.
• Adhere to all applicable service level agreements (SLAs).
• Establish appropriate reserves in accordance with SLAs and conduct regular reviews throughout the claim lifecycle, ensuring estimates remain accurate and within delegated authority.
• Evaluate damages by calculating applicable losses or ranges permitted by law.
• Negotiate settlements using effective strategies and available tools within delegated authority, referring matters that exceed authority levels as required.
• Deliver high standards of customer service through proactive communication and timely responses in accordance with service protocols.
• Manage litigated claims by instructing approved legal representatives where appropriate, setting litigation strategies and budgets, coordinating activities, reviewing settlement opportunities, monitoring expenses, and authorising payments within authority.
• Ensure full compliance with applicable legal, regulatory, and internal control requirements.
• Pursue and secure appropriate contributions and recoveries.
• Escalate suspected fraudulent claims to management promptly.
• Support profitable growth by identifying risk insights, trends, and emerging exposures.
• Act as a technical resource by mentoring junior claims professionals and sharing expertise within the relevant line of business.
• Safeguard organisational reputation by maintaining confidentiality and treating customers fairly at all times.
• Maintain and enhance professional and technical knowledge through ongoing education, awareness of industry developments, and participation in professional networks.
• Contribute to team objectives and support projects as required.
• Identify and resolve issues by applying policies, procedures, and standards to ensure consistency and quality outcomes.
• Take ownership of personal development and seek guidance from senior colleagues on complex matters to promote continuous improvement.
• Demonstrate commitment to organisational values and collaborative teamwork.
• Stay informed of relevant legal, regulatory, and medical developments.
• Take a proactive approach to claims handling, promoting early resolution where appropriate to minimise claim duration and associated costs.
• Ensure all valid policy obligations are fulfilled and that customers are treated fairly in accordance with applicable conduct requirements.
• Participate in audits, due diligence exercises, and policyholder meetings when required.
• Comply with all organisational policies and compliance requirements, maintaining confidentiality and representing the organisation professionally at all times.