Claims Associate Representative

1 month ago

Seville, United States ohio farmers insurance Full time

The Claims Associate Representative works in a team environment under direct supervision to determine coverage and investigate, analyze, negotiate, and settle claims. The role performs standard duties utilizing routine procedures on claim assignments of low complexity. The role prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties, facilitates and supports the execution of action plans and delivers high quality customer services in a low complex work environment and informs claimants as needed. Assists in determining whether proper coverage exists and investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, and damages, and makes decisions on claim resolution. Ensures customer service excellence and is responsible for the customer and agent experience associated with assigned claims. Maintains effective and ongoing communications with insureds, claimants, agents, other insurance companies, representatives, vendors, and company personnel. Assists in establishing and reviewing proper reserves for each claim based upon thorough investigation, evaluation and experience, and completing appropriate reports so that the status of the claim is clearly always documented. Investigates thoroughly to obtain relevant facts on claims coverage, liability, potential exposure, damages etc. and makes decisions, where appropriate, on claim resolution. Gathers facts by contacting involved parties to determine legal responsibility, damage causation, reviews data regularly and tracks and reports trends. Provides support in monitoring ongoing case development for appropriateness, obtains necessary documentation to support claims evaluation and recognizes claim file exposures, escalates, and completes appropriate reports so that the claim status is clearly documented. Establishes and maintains positive relationships with internal and external customers resolving conflict around disputed benefits and providing excellent customer service. 0-2 years of Claims Handling experience. 1 year of Customer Service experience.

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