JOB SUMMARY: Investigates, evaluates, negotiates and brings to a final resolution liability and/or bodily injury claims of a moderate to severe nature. Responsible for the handling of claims in accordance with prescribed authorization and according to claims best practices.
LOCATION: Casualty Claims Standard
RELATIONSHIP: Reports to Claims Manager
JOB RESPONSIBILITIES:
1. Handles to conclusion claims involving moderate to severe bodily injury and standard/ non-standard personal line claims.
2. May serve as the single point of contact for more complex material damage claims involving liability issues.
3. Determines proper policy coverage?s and applies best claims practices to conclude assigned cases in accordance with company guidelines. Adheres to high standards of professional conduct while providing delivery of superior claims service.
4. Establishes and authorizes adequate reserves and claims payments within the delegated authority.
5. Maintains current knowledge of: all insurance lines; court decisions; state unfair claims practice acts; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars and/or training sessions.
6. Initiates and conducts follow-ups via proficient use of claims systems and related business systems.
7. Submits administrative reports as required.
8. Properly maintains all assigned company equipment.
9. Performs all other duties as required.
JOB REQUIREMENTS:
Education/Knowledge: Undergraduate degree preferred. On-going job-related continuing education preferred. State licensing where required. Successful completion of required claims certification schools/classes. Knowledge of claims best practices, medical terminology, and the resolution of moderate to severe bodily injury claims.
Experience: Four years related casualty claims experience.
Skills: Analytical skills necessary to make decisions and resolve conflict in such areas as application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Ability to successfully negotiate BI claims including the ability to interpret medical reports. Organizational skills to effectively prioritize work. Command of written and verbal communication skills for contact and/or negotiate with policyholders, claimants, repairpersons, attorneys, physicians, agents and the general public. Ability to effectively operate a personal computer and related claims and business software.
JOB CONDITIONS:
Overtime Eligibility: Not Eligible (Exempt).
Working Conditions: Field environment. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) with multiple on-site responsibilities or for extended periods of time. Extended and/or non-standard hours as required.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Credit Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
