Claims Representative

Job Purpose:

Responsible for the investigation, evaluation, negotiation and resolution of assigned claims, as well as providing policyholders with basic risk management assistance and guidance.

Essential Functions

1. Effectively investigate, evaluate, negotiate and resolve claims presented against the insured’s of the company within department procedures. Apply medical expertise, solicit subject matter experts and conduct research as needed. Includes working with defense attorneys, claimant, claimant’s attorney, and insured. Monitor, evaluate and direct the legal counsel employed for the defense of insured’s claims within settlement authority. Handle assigned claims, including court ordered appearances and mediations.

2. Confirm coverage and evaluate petitions as filed against insured. Present appropriate recommendations to Litigation Consultant or Vice-President of Claims in a timely manner.

3. Assist insureds by answering questions, referring to counsel as needed and provide guidance.

4. Performs other job related duties as assigned.

Requirements:

Education: College degree or equivalent experience. Adjuster license or ability to obtain within 90-120 days if not already licensed.

Experience: 3-5 years claims experience with emphasis on general and professional liability claims and/or legal claims experience. AIC, SCLA, RPLU or other professional designations preferred.

Skills: Requires negotiation skills, excellent verbal and written communication skills. Excellent presentation skills and interpersonal skills. Requires ability to develop expertise in assigned line of malpractice (chiropractic, medical or dental). Requires knowledge of company coverages, policy terminology and legal concepts. Must maintain confidentiality.

Mental Demands: Must have the ability to focus on task for extended periods of time. Must be flexible and have the ability to work with a variety of tasks and employees. Ability to plan, organize, be detail and deadline oriented and maintain a high accuracy rate. Must be able to interpret data/problem solve and make effective decisions with limited or incomplete information.

Physical Demands: Continuous sitting for extended periods of time, some standing, walking, bending and reaching. Frequent use of fingers and hands to manipulate computer, telephone and other office equipment. Must be able to travel and work flexible hours. Ability to be able to look and concentrate at a computer/monitor for extended periods of time.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)