Inside Property Senior Claim Rep

6 days ago

Westfield Center, Ohio, United States Westfield Insurance Full time

Job Summary

Westfield Property Claims resolves first party personal, commercial, and agriculture property claims, which includes but is not limited to structural damage, business and personal property, and business income claims. The Inside Claims Senior Representative serves as a technical expert on first party property claims adjusting. The role determines applicability of coverage, investigates, establishes damages, negotiates, and settles claims. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team.

Job Responsibilities

  • Determines whether proper coverage exists for the type of claim assigned.
  • Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, legal climate, potential exposure, damages, and makes decisions on claim resolution.
  • Determines the value of physical damage of property, through appropriate tools and vendors, recognizes claim file exposures and escalates claims appropriately based on claim severity and complexity.
  • Provides support in negotiation of settlements with insureds, attorneys, and other insurance companies.
  • Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets.
  • Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards.
  • Establishes proper reserves for each claim based upon thorough investigation, evaluation, and experience.
  • Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations.
  • Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker.
  • Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing.
  • Requests additional information from an agent or other parties to assist in the claim investigation
  • Maintains effective and ongoing communication with insureds, agents, attorneys, other insurance companies, representatives, vendors, and company personnel.
  • Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation.
  • Interprets complex and detailed documents such as contracts, legal documents, insurance regulations and policies as needed.
  • Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices.
    For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned.

Job Qualifications

  • 4+ years of Claims Handling experience.
  • Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience.
    For field roles only: Valid driver's license and a driving record that conforms to company standards.

Location

Remote

Licenses and Certifications

Certified Professional Claims Management (CPCM) (preferred)

Behavioral Competencies

  • Collaborates
  • Communicates Effectively
  • Customer Focus
  • Decision Quality
    Nimble Learning

Technical Skills

  • Account Management
  • Claims Investigations
  • Claims Adjustment
  • Financial controls
  • Case Management
  • Customer Relationship Management
  • Project Management
  • Business Process Improvement
  • Auditing
    Data Analysis and Reporting

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

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