Claim Representative III

RESPONSIBILITIES/TASKS

• Verifies commercial auto coverage.
• Determines compensability by thorough investigation of the claim.
• Determines causal relationship to ensure appropriate payment of benefits.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages bills directly associated with the claim. Approves payment where appropriate.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.

ADDITIONAL RESPONSIBILITIES/TASKS

• Administers complex claims and catastrophic exposures within authority.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.
• Counsels and trains new employees.
• Coordinates special projects.

EMPLOYMENT QUALIFICATIONS

• EDUCATION OR EQUIVALENT EXPERIENCE:
  • Claim Representative I, II, III: Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree.
  • Continuous learning, as defined by the Company’s learning philosophy, is required.
  • Certification or progress toward certification is highly preferred and encouraged.
• EXPERIENCE:
  • Claim Representative I: Minimum one-year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program .
  • Bilingual skills preferred.
  • Claim Representative II: Three years’ experience in a commercial auto environment which provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing claims. Experience handling claims in multiple jurisdictions preferred.
  • Bilingual skills preferred.
  • OR One year of AF Group Claims Representative I experience that includes handling of difficult or complex claims.
  • Claim Representative III: Five years’ experience in a commercial auto environment provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing complex claims. Experience handling claims in multiple jurisdictions preferred.
  • Bilingual skills preferred.
  • OR Two years of AF Group Claims Representative II experience that includes discretion in determining compensability of complex claims and/or handling complex, high touch or labor-intensive customers.
• SKILLS/KNOWLEDGE/ABILITIES (SKA):
  • Claim Representative I, II, III: Ability and proficiency in the use of computers and company standard software specific to position.
  • Knowledge of medical and legal terminology related to the work.
  • Knowledge of commercial auto laws and regulations, including jurisdictional laws.
  • Effective oral and written communication skills.
  • Effective customer service skills.
  • Ability to negotiate, build consensus and resolve conflict.
  • Ability to manage multiple priorities and meet established deadlines.
  • Attention to detail and analytical skills.
  • Ability to work independently as well as within a team.
• ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA):
  • Claim Representative II, III: Ability to make independent decisions.
  • Ability to solve complex problems.
  • Claim Representative III: Ability to train and mentor others.
• WORKING CONDITIONS:
  • Work is performed in an office setting with no unusual hazards.
  • Minimal travel required.
• PAY RANGE:
  • Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors.
  • It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $64,000 and $108,700.
• WORKING CONDITIONS:
  • Work is performed in an office setting with no unusual hazards.
  • Minimal travel required.
• EQUAL OPPORTUNITY EMPLOYER:
  • We are an Equal Opportunity Employer.
  • Diversity is valued and we will not tolerate discrimination or harassment in any form.
• CANDIDATES FOR THE POSITION STATED ABOVE ARE HIRRED ON AN "AT WILL" BASIS.
• Nothing herein is intended to create a contract.