Directly handle a technical claims caseload of a specific nature. Caseload typically comprised of files arising from a limited range of coverage’s and possessing up to moderate financial exposure The primary emphasis is on producing thorough, accurate and courteous claims adjustments for our policyholders and claimants. Such claims infrequently involve substantive coverage issues or litigation. Reasonably conclude claims promptly and equitably within the provisions of the insurance policy and in accordance with known damages and legal requirements. All files handled will comply with claim file handling guidelines and all other job expectations, regulations and requirements.
DUTIES & RESPONSIBILITIES
- Conduct and coordinate investigations on all assigned claims.
- Negotiate the settlement of claims within assigned authority.
- Maintain accountability for all assigned claims until disposition is reached.
- Document all activity on assigned claims and assure control of independent vendors.
- Review new losses and files on diary to ensure reserve adequacy while keeping management informed of adverse developments.
- Monitor loss adjustment expense and take steps to contain file expenses.
- Utilize vendors judiciously to maximize value added.
- Review coverage questions and work with supervisor and claim management for approval.
- Refer appropriate coverage matters to the Team Leader, Claim Supervisor or Manager.
- Ensure appropriate file handling, documentation, reporting, and expense control.
- Provide accurate and timely information to all external and internal customers concerning claim status and other claim inquiries.
- Meet with policyholders and agencies as needed.
- Attend trials, depositions, EUO’s, appraisals and mediations where beneficial or required.
- Suggest improvements of processes within the department to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, etc.
- Participate in setting file direction and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting.
- Deliver technical training for agents, peers and clerical personnel upon request.
- This position directly handles an assigned claim caseload.
- The Claim Representative may also be responsible for performing some administrative functions.
- Performs other duties or special projects as required or as assigned.
The Claim Supervisor or Team Leader provides direct moderate to minimal supervision.
- Bachelor's degree in business, insurance or a related field, or its equivalent; two or more years of relevant claim technical experience; or a combination of education and experience from which comparable knowledge and skills are acquired.
- Appropriate state Adjuster’s License(s) where required by law.
- For field based positions, previous outside experience is preferred and valid driver’s license is required.
- Sound knowledge of the technical aspects of property and/or casualty claims related to the core responsibilities expected of the position.
- Demonstrated commitment to professional development through continuing education related to the job such as AIC, AEI, INS, SCLA or CPCU certification coursework, etc.
- Developing skills in specialized technical disciplines; including working knowledge of relevant contract and tort law.
- General understanding of the insurance industry and company operations.
- Solid analytical, and negotiation skills.
- Good verbal and written communication skills.
- Ability to exercise sound judgment in dealing with professional situations and confidential information.
- Ability to work effectively with a wide range of outside firms and organizations.
- Ability to deal effectively with company management peers and support staff.
- Strong customer service orientation.
- Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); imaging and estimating programs.
- Ability to perform job duties under stressful conditions.
- Perform other duties or special projects as required or assigned.
PHYSICAL DEMANDS/WORKING CONDITIONS
- Typical office, field or residence based working environment.
- For field based positions, regular outside automobile day travel of approximately 50% is expected.
- For non-field positions, predominately sedentary office position with high frequency of keyboarding/computer work required.
- Occasional overnight travel.
- Potentially subject to adverse weather and stressful situations with respect to claim disputes.
How to Apply:
Submit cover letter, salary requirements and resume, in strict confidence.