Customer Service Representative

2 days ago

Jacksonville, United States Ascendo Resources Full time

We are hiring for a Claims Examiner for a local insurance company. In this role you will be responsible for analyzing, reviewing, and processing property and casualty (P&C) insurance claims to ensure timely and accurate settlement in accordance with company policies, procedures, and regulatory guidelines. The role involves assessing claim validity, investigating facts, determining coverage, and negotiating settlements, while providing excellent customer service.


Key Responsibilities


Claims Processing

  • Review and analyze insurance claims to determine validity and coverage under existing policies.
  • Ensure claims are processed accurately and in compliance with state and federal regulations.

Investigation

  • Conduct thorough investigations, including reviewing policy details, obtaining statements, and gathering evidence such as photos, police reports, and repair estimates.
  • Collaborate with adjusters, appraisers, and other professionals to verify facts and assess damages.

Evaluation & Settlement

  • Evaluate claims to determine appropriate settlement amounts based on policy terms and loss conditions.
  • Negotiate settlements with claimants, legal representatives, or third parties while maintaining fairness and adherence to company policies.

Documentation

  • Maintain accurate and detailed records of claims, correspondence, and decisions in the company’s claims management system.
  • Prepare reports summarizing claim trends, issues, and recommendations for management.

Compliance & Risk Management

  • Stay current with industry standards, legal requirements, and company protocols related to P&C insurance.
  • Identify and report potential fraud or suspicious activities.

Customer Service

  • Communicate claim decisions and settlement offers clearly and professionally to claimants and stakeholders.
  • Provide guidance and support to policyholders during the claims process.


Qualifications


Education: Bachelor’s degree in insurance, business administration, or a related field preferred.

Experience: 2-5+ years of experience in P&C claims handling, underwriting, or a related insurance role.

Skills:

  • Strong analytical and decision-making abilities.
  • Excellent communication and negotiation skills.
  • Proficiency with claims management software and Microsoft Office.
  • Knowledge of state and federal insurance regulations.

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