Claim Representative III - GL/Commercial Auto

Responsibilities

• In accordance with application of state and federal laws and company best practices, gather and review claim information, determine coverage, determine duty, and conduct liability investigations.
• Initiate and maintain contact with claim parties to provide updates and resolve issues timely.
• Update the claim system to document claim handling activities throughout the life of the claim.
• Determine, set, and maintain reserves and issue payments in line with a level of authority.
• Review contracts and thoroughly investigate risk transfer possibilities.
• Investigate and refer identified claims to Loss Recovery Services, as applicable.
• Direct vendors and review reports to evaluate exposure.
• Manage and direct counsel when litigation is involved.
• On any given day, perform claim tasks timely and document claim files appropriately.
• Proactively manage claim activities to ensure fair claim resolution.
• Handle all claims in accordance with state and federal laws.
• Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner.
• Deny losses within authority level, providing detailed explanation, citing facts, and policy language.
• Perform a thorough investigation based upon the type, complexity, and severity of the claim.
• Upon completion of the investigation, analyze and evaluate the potential exposure and damages, including potential full or partial liability and compensability denials.
• Formulate and document an action plan based on the covered damages and injuries.
• Determine and set reserves based on the most probable outcome of the claim, within authority level.
• Evaluate and negotiate directly with insured, claimant, or claimant's attorney on all cases within authority level.
• Review claim facts and exposure with claims management, as appropriate, to guide claim strategy.
• Make complete, accurate, and timely payments within authority for covered losses.
• Refer claims above authority to appropriate team member for review and potential reassignment.
• Maintain a professional, courteous, and helpful approach when communicating in-person, on the phone, or through email and other correspondence with internal and external customers, business partners and brokers.
• Recognize when vendor partners are required on a claim, including experts, independent adjustors, nurses, defense attorneys, etc.
• Assign and direct vendors, as needed, to aid in the investigation and evaluation of the claim.
• Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim.
• Act as a resource to share knowledge and experience with other claim handlers.
• Assist and support their development with mentoring and auditing functions.
• Negotiate settlements, attend mediations, attend settlement conferences, engage in various ADR opportunities.

Requirements

• Minimum of seven years claim handling experience is required.
• Three years of litigation management experience is preferred.
• Education Bachelor's degree preferred.
• A combination of equivalent education and/or experience may be considered in lieu of a degree.
• Additional training in insurance, medical, and/or building terminology knowledge is desirable.
• Completion of INS, AIC, or CPCU is preferred.
• Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.

Skills

• Ability to work independently and manage workload timely.
• Strong listening, verbal, and written communication skills.
• Proficient knowledge of policy terminology and legal principles involving at least one or more of the following: insurance, automobile, medical and property claims.