Senior Claims Representative

8 hours ago

Montpelier, Vermont, United States Vermont Mutual Full time
Job Title: Sr. Claim Representative

As a Sr. Claim Representative at Vermont Mutual, you will play a critical role in handling a diverse claims caseload, including multiple coverage feature types and a large percentage of losses of moderate complexity and financial severity.

Key Responsibilities:
  • Conduct and coordinate loss investigations on all assigned claims.
  • Negotiate the settlement of claims within authorized amounts or specific file authority.
  • 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, EUOs, 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.
Requirements:
  • 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 a 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.
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.
  • Predominantly 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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