Role Overview

Insurer
Flexible Location

I am currently partnered with a leading Insurer who are seeking a Senior Claims Adjuster to join their disease team. This role will be handling complex Mesothelioma Cancer Claims from FNOL to settlement, arising from the UK&I.

Key Responsibilities

• Manage and maintain accurate claims records, ensuring all claims data and information is captured and updated in accordance with industry best practice and the technical complexity and exposure of each claim.
• Assess liability by gathering and analysing relevant facts, applying applicable legislation, policy terms and principles of negligence and breach of duty.
• Manage a substantial volume of high-value and highly complex claims, exercising sound independent judgement and making informed decisions with minimal supervision.
• Review policy terms and determine coverage by analysing the circumstances of each claim and establishing whether the loss falls within the applicable policy coverage.
• Develop appropriate claims strategies and case evaluations to achieve timely and effective resolution, escalating complex or material issues where appropriate.
• Ensure compliance with applicable service level agreements (SLAs), including the timely progression and resolution of claims.
• Establish appropriate reserves within delegated authority and review reserves throughout the claims lifecycle, ensuring they accurately reflect the anticipated value and exposure of each claim.
• Assess and quantify damages by applying relevant legislation, case law and established principles to determine appropriate settlement values or ranges.
• Develop and implement effective negotiation strategies to achieve appropriate and commercially sound settlements within delegated authority, escalating matters where required.
• Maintain a high standard of customer service through proactive communication, timely responses to enquiries and clear, professional engagement with policyholders, representatives and other stakeholders.
• Manage litigated claims by instructing appropriate legal representatives, establishing litigation strategies and budgets, coordinating legal activity, monitoring costs and continuously assessing opportunities for settlement.
• Ensure all claims activity complies with applicable legislation, regulation, policy requirements and internal controls.
• Identify and pursue appropriate contribution and recovery opportunities to minimise overall claims costs.
• Identify potential indicators of fraud and escalate concerns in accordance with relevant procedures.
• Provide insight into emerging risks, claims trends and portfolio developments to support effective risk management and sustainable business performance.
• Act as a technical resource and subject matter expert, providing guidance, mentoring and technical support to less experienced claims professionals.
• Maintain strict confidentiality of claims and customer information while ensuring customers are treated fairly and consistently.
• Maintain and develop professional and technical knowledge through ongoing learning, industry engagement, professional networking and awareness of emerging developments.
• Keep up to date with relevant legal, regulatory and medical developments and assess their potential impact on claims management and decision-making.
• Proactively manage claims with a focus on early intervention and appropriate settlement strategies to minimise claims lifecycle, legal costs and overall exposure.
• Ensure valid policy obligations are appropriately fulfilled and that customer outcomes remain fair, consistent and compliant with applicable conduct requirements.
• Prepare clear, concise and accurate written and verbal reports, including providing updates and recommendations to senior stakeholders where required.
• Participate in audits, due diligence exercises and policyholder meetings as required.
• Identify and resolve complex claims issues by applying relevant policies, procedures, technical standards and professional judgement to ensure consistent, high-quality outcomes.
• Act as a technical expert within the wider claims team, providing support and guidance on complex matters and determining when additional input or escalation is required.
• Contribute to team objectives and wider projects, sharing knowledge and supporting continuous improvement across claims processes and practices.
• Demonstrate professionalism, integrity, accountability and effective teamwork in all aspects of claims management.