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Claims Representative, APD

1 month ago

Wyomissing, Pennsylvania, United States CNA Full time

JOB DESCRIPTION

Essential Duties & Responsibilities:

As a Claims Representative, APD, you will perform a combination of duties in accordance with departmental guidelines:

  • Manage an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit.
  • Contribute to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
  • Verify coverage and establish timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols.
  • Exercise judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim.
  • Work with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes.
  • Authorize and ensure claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
  • Develop ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
  • Identify and address subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation.
  • Achieve quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
  • Maintain compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.

May perform additional duties as assigned.

Reporting Relationship

Typically Manager or above

Skills, Knowledge & Abilities

  • Develop basic knowledge of the commercial insurance industry, products and claim practices.
  • Good verbal and written communication skills with ability to demonstrate empathy while providing exceptional customer service.
  • Ability to develop collaborative business relationships with both internal and external work partners.
  • Able to exercise independent judgement, solve basic problems and make sound business decisions.
  • Analytical mindset with critical thinking skills.
  • Strong work ethic, with demonstrated time management and organizational skills.
  • Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
  • Knowledge of Microsoft Office Suite and ability to learn business-related software.
  • Adaptable to a changing environment.
  • Ability to value diverse opinions and ideas.

Education & Experience:

  • High school Diploma required. Associates or Bachelor's Degree preferred.
  • Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
  • Prior claim handling, or business experience in the insurance industry and/or customer service is preferred.