Claims Representative

Responsibilities

• Promptly reviews and acts with urgency in establishing initial and subsequent contact with all parties and key stakeholders.
• Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Effective and timely communication with insureds, insured general counsel, and make exceptional customer service a top priority.
• Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
• Coverage Analyzes and interprets policy language in conjunction with specific loss facts to reach appropriate coverage decisions.
• Proactively communicates with internal and external stakeholders, including insured’s, regarding coverage decisions.
• Maintain discipline in securing and updating key information within the claim handling platform throughout the life of the claim.
• Establishes and maintains appropriate initial and subsequent loss and expense reserves throughout the life of the claim.
• Act with urgency in collaborating with internal stakeholders regarding significant changes within claim reserving.
• Investigate each claim through prompt and strategically appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers, and technical experts to determine the extent of liability, damages, and contribution potential.
• Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
• Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.
• Utilize diary management system to ensure that all claims are handled timely.
• At required time intervals, evaluate liability and damages exposure.
• Manage vendors involved with claim files, i.e., Independent Adjusters, Defense Attorneys, and Coverage Counsel.
• Attend and/or present at roundtables/authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
• Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.
• Aid in coaching, training, and mentoring team members.
• Maintain current knowledge of insurance line, court decisions which may impact the claim function, current guidelines in the claim function, and policy changes and modifications.
• Attend professional and/or continuing educational seminars and classes.

Qualifications

• Bachelor’s degree required or prior related insurance experience.
• Insurance related designation (AIC, SCLA and/or CPCU), preferred.
• Have, or ability to obtain adjuster license in required states.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Excellent analytical and problem-solving skills.
• Self-starting, self-motivated and capable of making decisions independently.