• The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance. • Conduct phone and/or field investigations to determine liability and damages. • May attend and participate in legal proceedings. • Identify and obtain statements from insureds, claimants and witnesses. • Communicate and interact with a variety of individuals including insureds and claimants. • Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. • Recognize and appropriately address moderate complexity coverage issues. • Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data. • Negotiate within settlement authority with insureds and claimants to resolve first and third party claims. • Update database production reports, and document and update claim files via company systems. • Control expenses for areas of responsibility. • Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. • Coordinate with internal and external departments as required. • Respond quickly to customer needs and problems. • Independently resolve claims within authority level.

• Analyze and process low to mid-level auto and transportation claims. • Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. • Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution. • Identifies and pursues subrogation opportunities; secures and disposes of salvage. • Communicates claim action/processing with insured, client, and agent or broker when appropriate. • Maintains professional client relations. • Performs coverage, liability, and damage analysis on all claims assignments. • Performs other duties as assigned. Supports the organization's quality program(s).

• Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies. • Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively. • Build and maintain customer relationships through timely and accurate policy service. • Document and process loss information accurately to assess potential damages. • Participate in quality control tasks, audits, risk assessments, and field reviews. • Contribute to a positive work environment by demonstrating cultural expectations and influencing others positively. • Support business objectives through quality control tasks, audits, and risk assessments.

• Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission • Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues • Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate • Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines • Perform payer research and communicate directly with insurance carriers to resolve claim processing issues • Monitor assigned work queues and ensure timely resolution of outstanding claims • Escalate complex reimbursement, coding, or compliance issues to senior team members • Partner with A/R and Denials Management teams to resolve denied and underpaid claims • Assist in preparing appeal documentation and supporting materials for denied claims • Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator • Maintain accurate documentation of denial resolution activities and payer communications • Support efforts to reduce preventable denials and improve reimbursement outcomes • Work closely with the pre-billing team to identify and correct claim issues prior to submission • Review claims for completeness and compliance with payer billing requirements • Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage • Collaborate with coding and clinical teams to obtain information needed for claim resolution • Assist with reducing claim holds and billing delays • Participate in routine claim quality reviews and internal audit activities • Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines • Support Revenue Integrity initiatives through accurate claim review and documentation • Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements • Adhere to HIPAA, CMS, and organizational compliance standards • Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities • Track assigned workloads and resolution outcomes • Assist with compiling information for denial trend reporting and operational reviews • Provide feedback regarding workflow issues contributing to claim errors or payment delays • Assumes other responsibilities as appropriate to the position and organizational needs