Claims Representative
3 weeks ago
- Review new claims assignments to determine the nature and severity of the claim and intended action required.
- Manage and execute all claim functions such as maintaining proper claims documentation within the claims management system, reserving, claim payments, expense factors, and file notes.
- Make prompt, meaningful contact with insureds or claimants.
- Maintain proper communication channels with internal and external customers as defined by claims best practices.
- Conduct a timely and thorough investigation to identify risks/exposures which may include: conducting interviews, procuring recorded statements, relevant documents, and identifying others possessing facts or involvement with the claim - to determine the extent and severity of potential loss.
- Evaluate, manage, and/or recommend claim file reserves.
- Review and interpret policy to determine coverage.
- Determine and communicate liability decision with all relevant parties.
- Inform underwriting if increased hazards or unusual circumstances concerning a risk/policy exposure.
- Disposition of claims through effectively negotiating and settling and/or denial.
- Actively identify subrogation potential and posture claim for successful subrogation.
- Recognize and promptly address litigation potential, work cohesively with defense counsel, and attend mediation and settlement conferences as needed.
- Participate in continuing educational programs to develop and maintain knowledge of products, procedures, and industry trends.
- Process first and third-party claims with clear liability and no injury.
- Investigate and process non-complex claims.
- Handle non-attorney represented claims.
- Education: High school diploma, 2 or 4-year degree preferred.
- Certifications/Designations: None required, within 2 years of hire, must begin working toward AIC and other designations deemed appropriate by supervisor.
- Meet the appropriate state licensing laws required to handle "multi-line" claims.
- Experience: 1+ years of general work experience.
- Knowledge, skills & abilities: Claims best practices, familiar with policies, aware of unfair claims practices, knowledge of venue and regulations, basic legal terminology, knowledge of available resources, customer-focused, communication, time management/multi-tasking, embrace change & ambiguity, social awareness, problem-solving, analytical thinking, negotiation, optimize work processes, decision quality.
- Working out of home or office (general office conditions), and/or occasional field assignments as agreed with Regional Claims Manager and Supervisor.
- Some exposure to high stress/fast-paced environment.
- Travel might be required on occasion.
- Lifting/carrying up to 50lbs might be required on occasion.
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