Key Responsibilities and Required Skills for Unrepresented Casualty Adjuster

🎯 Role Definition

We are seeking a seasoned Unrepresented Casualty Adjuster to independently manage third‑party bodily injury and liability claims where claimants are not represented by counsel. The Unrepresented Casualty Adjuster will lead timely investigations, evaluate liability and damages, negotiate voluntary settlements, set and maintain appropriate reserves, coordinate medical and vendor resources, and manage files through closure while protecting the insurer’s legal, financial and reputational interests. Ideal candidates demonstrate strong legal and coverage analysis, exceptional written and oral communication, efficient case management in a claims system (e.g., Guidewire/ClaimCenter or equivalent), and the judgment to escalate litigation matters when exposure exceeds authority.

📈 Career Progression

Typical Career Path

Entry Point From:

Claims Assistant / Claims Representative transitioning into liability work
Field Adjuster or Auto Adjuster with experience in BI and third‑party claims
Paralegal or Litigation Support Specialist with exposure to injury files

Advancement To:

Senior Casualty Adjuster / Senior Liability Adjuster
Liability Team Lead or Supervisor
Claims Litigation Manager or Litigation Specialist
Claims Manager or Regional Claims Director

Lateral Moves:

Subrogation Specialist
Coverage Analyst / Coverage Counsel
Special Investigations Unit (SIU) Investigator

Core Responsibilities

Primary Functions

Conduct thorough investigations of unrepresented third‑party casualty claims by obtaining, reviewing and documenting police reports, witness statements, photographic evidence, scene diagrams, and physical inspection results to determine initial liability exposure and coverage implications.
Analyze policy language and limits to perform accurate coverage determinations and advise underwriting and legal teams on potential coverage defenses, exclusions, and reservation of rights when necessary.
Evaluate medical records, bills, treatment summaries, and future medical projections — coordinating with medical consultants or nurse case managers when required — to quantify past and projected damages for bodily injury claims.
Prepare detailed file notes, liability reports, chronology, and demand/response correspondence that document factual findings, legal analysis, settlement strategy, and the rationale for reserve recommendations in the claims management system.
Set, monitor, and adjust claim reserves based on evolving facts, medical opinions, litigation status and economic exposure, ensuring reserves reflect both indemnity and expense exposures and comply with corporate reserving guidelines.
Negotiate settlements directly with unrepresented claimants, employing documented negotiation strategies, objective valuation methods and business rules to achieve fair and timely resolutions while minimizing unnecessary litigation.
Manage litigation and attorney relationships by coordinating defense counsel assignments, providing clear litigation strategy and file documentation, authorizing legal work within authority limits, and reviewing defense fee invoices for appropriateness.
Authorize and manage vendor services such as independent medical exams (IMEs), accident reconstruction, vocational experts, economic loss calculations, and investigative resources to support claim evaluation and defense.
Respond to coverage requests, UM/UIM inquiries, and coordination of benefits issues; prepare and issue appropriate reservation of rights, coverage declination, or coverage acceptance letters with legal review when required.
Identify potential bad faith, regulatory or statutory exposure, escalate high‑risk matters to claims management and legal counsel, and implement risk mitigation actions (e.g., early mediation, structured settlements) to limit company exposure.
Perform timely liability and causation analyses in motor vehicle, premises liability, product liability, and general liability loss scenarios, applying jurisdictional law and comparative fault principles to estimate recovery potential and defense strategy.
Draft and serve routine claims correspondence including demand responses, settlement agreements, releases, subrogation notices, and draft pleadings in coordination with counsel when transitioning to litigation.
Coordinate with internal teams (underwriting, risk control, medical management, subrogation) to identify recovery opportunities, policy coverage issues and root causes that reduce future loss frequency or severity.
Manage discovery logistics and preparation for depositions by organizing medical records, witness lists, exhibits, and timelines; coordinate with litigation counsel to prepare the company’s witnesses and document production.
Conduct field visits and site inspections when appropriate to preserve evidence, corroborate claimant statements, measure scene conditions, and document environmental risk factors that inform liability assessments.
Utilize claim systems (e.g., Guidewire ClaimCenter, ClaimXperience, CCC, or insurer proprietary platforms) and Microsoft Office tools to maintain accurate file status, produce management reports, and meet established file handling SLAs.
Maintain strict file hygiene and regulatory compliance by completing statutory notices, filing required forms, adhering to state adjuster licensing rules, and meeting internal audit and quality assurance standards.
Identify potential fraudulent activity or suspicious patterns, refer matters to Special Investigations Units (SIU) and support investigative processes by compiling and delivering clear evidentiary packages.
Evaluate subrogation potential and coordinate recovery efforts with subrogation specialists, building documentation to support recovery demands and offset indemnity payments where appropriate.
Implement cost containment strategies by evaluating medical provider billing, questioning unreasonable expense items, negotiating lien reductions where applicable, and recommending utilization review when appropriate.
Monitor litigation calendars, trial dates, statute of limitation deadlines and indemnity claim milestones to ensure timely defense actions and to avoid exposure from missed deadlines.
Prepare concise executive summaries for high exposure or complex files that outline facts, exposures, reserve history, settlement posture, and recommended strategy for senior management review.
Participate in catastrophe response and surge claim efforts as needed, performing remote or field adjusting to triage and evaluate multiple-stream casualty exposures during major events.
Provide mentorship and training to less-experienced adjusters on casualty claim handling best practices, negotiation techniques and documentation standards.

Secondary Functions

Contribute to continuous improvement initiatives by identifying process gaps in claim workflow and recommending automation, template or playbook enhancements to improve speed and consistency of claim resolution.
Support internal and external audits by preparing claim samples, providing file narratives and responding to findings with corrective action plans.
Collaborate with data analytics or business intelligence teams to supply claim-level insight that informs predictive modeling, reserving accuracy and fraud detection algorithms.
Participate in cross-functional committees focused on liability trends, legal developments, and regulatory changes affecting casualty claims handling.
Conduct occasional training sessions for customer service, intake and field teams to ensure consistent handling of unrepresented claimant inquiries and early-interview best practices.
Assist in vendor sourcing, vendor performance reviews and RFP processes for expert witnesses, IME providers and investigation services.

Required Skills & Competencies

Hard Skills (Technical)

Extensive knowledge of casualty claims handling for unrepresented claimants, including motor vehicle, premises liability, product liability and general liability exposures.
Policy language and coverage analysis skills, including drafting and issuing reservation of rights, denial and coverage position letters.
Strong liability and damages evaluation skills, with the ability to synthesize medical records and expert reports to produce credible settlement valuations.
Litigation management experience: working with defense counsel, coordinating discovery and preparing files for suit and trial.
Proficiency with claims management systems (Guidewire ClaimCenter, ClaimXperience, CCC, or equivalent), with demonstrated ability to produce reports and maintain compliant file documentation.
Reserve setting and financial exposure analysis, including experience with indemnity/expense reserving conventions and reporting to management.
Vendor management experience (IME, investigators, reconstructionists, economists, vocational experts).
Familiarity with subrogation processes, lien resolution, Medicare/Medicaid coordination, and post‑settlement compliance (e.g., lien resolution).
Strong written-communication skills for drafting demand negotiations, settlement agreements, file summaries and legal correspondence.
Competency in Microsoft Office suite, particularly Word and Excel for chronology, exhibit production, and simple financial modeling.

Soft Skills

Excellent negotiation skills with demonstrated ability to close complex settlements with unrepresented claimants.
Superior verbal and written communication, comfortable explaining technical decisions to claimants, counsel and business stakeholders.
Sound judgment and decisive problem solving, able to make informed decisions under ambiguous facts and time pressure.
Empathy and customer-service orientation balanced with strong advocacy for company interests and cost control.
High organizational ability, managing a high-volume caseload while prioritizing litigation‑sensitive and high‑exposure matters.
Resilience and stress tolerance for handling difficult claimant interactions and emotionally charged injury files.
Team collaboration and mentorship capability, able to train and guide junior adjusters while working cross-functionally.
Attention to detail in legal/medical documentation, ensuring defensible files that withstand audit and litigation scrutiny.
Ethical decision-making and regulatory compliance awareness, maintaining adjuster licensing and state notice requirements.
Time management and deadline discipline, tracking statute of limitations, discovery deadlines and internal SLA targets.

Education & Experience

Educational Background

Minimum Education:

High School Diploma or GED required; post‑secondary coursework beneficial.

Preferred Education:

Bachelor’s degree in Risk Management, Insurance, Business Administration, Paralegal Studies, Legal Studies, or related field preferred.

Relevant Fields of Study:

Risk Management & Insurance
Business Administration
Paralegal / Legal Studies
Criminal Justice / Investigations
Health Sciences (for medical record interpretation)

Experience Requirements

Typical Experience Range: 3–7 years of hands‑on casualty and third‑party liability claim handling, including negotiation and litigation exposure.

Preferred: 5+ years managing unrepresented bodily injury claims with documented experience in high‑exposure files, litigation coordination, reserve management, and use of mainstream claims systems. Experience working with SIU, subrogation and medical bill resolution is a plus.