Claim Representative II

Directly handle a technical claims caseload of a specific nature. Caseload typically comprised of files arising from a broad range of coverage or perils and possessing a wide range of financial exposure and complexity. Such claims occasionally involve substantive coverage issues or litigation. Employee should possess demonstrated expertise in handling bodily injury claims which involve both comparative negligence theories and defenses, or confidently capable of writing detailed building or auto estimates. Conclude claims promptly and equitably within the provisions of the policy contract and in accordance with known damages and legal requirements. All files handled must comply with claim file handling guidelines and all other job expectations, regulations and requirements.

CHARACTERISTIC DUTIES & RESPONSIBILITIES

• Conduct and coordinate loss investigations on all assigned claims.
• Negotiate the settlement of claims within authorized amounts or specific file authority.
• Maintain accountability for all assigned claims until disposition is reached.
• Recommend further action on claims exceeding authority limits.
• Document all substantive activity on assigned claims and assist in the control of independent vendors.
• Review new losses and open files on diary to ensure reserve adequacy while keeping management informed of adverse developments.
• Monitor loss adjustment expense and take steps to mitigate 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 Claim Supervisor or Claim Manager.
• Ensure appropriate file handling, documentation, reporting and expense control of all files handled.
• Provide accurate, courteous and timely information to all eligible external and internal customers concerning claim status and other claim inquiries.
• Attend meetings with policyholders and agencies as needed.
• Serve as a technical resource within the department through mentoring and knowledge sharing.
• Draft coverage correspondence, including reservation of rights and coverage disclaimer along with composing detailed correspondence to insureds, claimants, attorneys, etc.
• Attend trials, depositions, EUO’s, appraisals and mediations where deemed beneficial or required.
• Improve processes within the department to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, systems implementation, etc.
• Participate in setting file direction and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting to management.
• Coordinate and deliver technical training for agents, peers and clerical personnel.
• This position handles an assigned claim pending.
• Performs other duties or special projects as required or as assigned.

SUPERVISION RECEIVED

The Claim Supervisor provides direct minimal supervision.

SUPERVISION EXERCISED

Primarily no supervisory duties; however limited supervision of independent adjusters and vendors may occur.

QUALIFICATIONS

• Bachelor's degree in business, insurance or a related field, or its equivalent
• Three 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 a valid driver’s license is required. Sound knowledge of the technical aspects of property and/or casualty claims related to the core responsibilities assigned to the position.
• Demonstrated commitment to professional development through continuing education related to the job such as AIC, AEI, INS, SCLA CPCU, etc.
• Established and improving skills in specialized technical disciplines; including working knowledge of relevant insurance, contract and tort law.
• Knowledgeable about the insurance industry and company operations.
• Sound analytical, and negotiations skills.
• Very good verbal and written communication skills.
• Ability to exercise sound judgment in dealing with professional and personnel situations.
• Ability to work effectively with a wide range of outside firms, etc.
• Ability to collaborate effectively with company management, peers and support staff.
• Demonstrated customer service orientation.
• Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); Experience with imaging and estimating programs preferred.
• Ability to perform job duties under stressful situations.

PHYSICAL DEMANDS/WORKING CONDITIONS

• Employees in this job classification may be based in a typical office or a remote location or residence as determined by management.
• For field based positions, regular outside automobile day travel of approximately 50% is expected.
• For non-field based positions, predominately sedentary office position with high frequency of keyboarding/computer work required.
• Occasional overnight travel required.
• Potentially subject to stressful situations with respect to claim dispute.
• May be exposed to adverse external conditions and inclement Weather.