Sr. Claim Representative
4 weeks ago
JOB SUMMARY
Directly handle a diverse claims caseload including multiple coverage feature types and a large percentage of losses of moderate complexity and financial severity. Claims assigned occasionally involve coverage issues or litigation. Employee should possess demonstrated expertise in handling significant bodily injury claims which involve both comparative negligence theories and defenses. Employee should be well versed in all coverage’s written with an emphasis on the more difficult losses and exposures, and be capable of seeing more difficult adjustments through final resolution using a wide variety of settlement techniques. 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 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 activity on assigned claims and assist in the 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 expenses and take steps to effectively manage costs of third party service providers.
- Utilize vendors judiciously to ensure maximum value from services.
- Review coverage questions and suggest interpretations to Claim Supervisor for approval.
- Refer appropriate coverage matters to the Claim Supervisor and/or Claim Manager.
- Ensure appropriate file handling, documentation, special reporting and expense control of all files handled inclusive of MSP compliance.
- Provide accurate, courteous and timely information to all eligible external and internal customers concerning claim status and other claim inquiries.
- Presents reports and leads discussion on files requiring roundtable Reviews with peers and management
- Provide service calls on policyholders and agencies as needed.
- 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 and mediations where deemed beneficial or required by jurisdiction. Suggest improvements to processes within the department to increase the level and quality of service provided to internal and external customers, e.g. workflow changes, systems implementation, etc.
- Effectively follow direction on complicated or high-exposure matters and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting to management.
- This position handles an assigned claim pending
- Performs other duties or special projects as required or as assigned.
SUPERVISION RECEIVED
The Claim Supervisor provides minimal direct supervision.
SUPERVISION EXERCISED
This job primarily has no supervisory duties; however moderate supervision of independent adjusters, vendors and claim support staff may occur.
QUALIFICATIONS
- Bachelor’s degree in business, insurance or a related field, or its equivalent.
- Five or more years of relevant technical claim handling experience with demonstrated achievement and progressive responsibilities; 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. Advanced knowledge of the technical aspects of casualty claims
- Demonstrated commitment to professional development through the attainment of recognized industry designations such as AIC, AEI, SCLA, CPCU programs, etc.
- Fully developed skills in specialized technical disciplines; including extensive knowledge of relevant contract and tort law.
- Sound understanding of the insurance industry and company operations. Strong analytical and negotiating skills.
- Very good oral and written communication skills.
- Demonstrated ability to exercise sound judgment in dealing with professional issues. Demonstrated ability to work effectively with a wide range of outside firms and organizations.
- Demonstrated ability to collaborate effectively with company management, peers and claim support staff.
- Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); Experience with imaging programs and claims handling systems preferred.
- Ability to perform job responsibilities under stressful situations.
PHYSICAL DEMANDS/WORKING CONDITIONS
- Employees in this job classification may be based in either a typical office environment or from a remote location or residence as determined by management.
- Predominately sedentary office position with high frequency of keyboarding/computer work required.
- Occasional overnight travel.
- Potentially subject to inclement weather and stressful situations with respect to claim disputes.
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