Claims Representative II

About the role

Settles mildly complex claims by determining insurance carrier’s liability and reaches agreement with claimant according to policy provisions and authority level.
May be involved with litigation by analyzing negotiated settlement options; evaluating evidence, and overseeing attorney in the handling of discovery and settlement.
Handles mediations, arbitrations, subrogation, and recorded settlement agreements.
Determines coverage through investigations by examining claim forms, policies, and other records; interviewing claimants, insureds, and witnesses; consulting police and hospital records; inspecting damages; and consulting with experts when appropriate.
Mentors and trains claims representatives in claims expertise by assisting in identifying training needs and opportunities.
Solves questionable claims by investigating the claim and comparing claims information with evidence.
Ensures proper file documentation of assigned files by complying with company and state requirements.

Responsibilities

• Handles represented bodily injury claims, with a strong emphasis on Commercial General Liability (CGL) and premises liability exposures.
• Negotiates out-of-court settlements for mildly complex general liability claims.
• Analyzes and evaluates evidence related to claims.
• Interviews claimants, insureds, and witnesses.
• Consults police and hospital records.
• Inspects damages and consults with experts when necessary.
• Provides guidance and support to junior claims representatives.
• Prepares reports summarizing claim information.
• Collaborates with underwriting to determine investigation guidelines.
• Participates in catastrophe teams and provides feedback as needed.

Requirements

• Bachelor’s Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience.
• Proficiency in general liability claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.
• Ability to obtain and maintain proper licensing prior to handling a state that requires it.
• Professional insurance designations highly desirable.
• Litigation experience highly desirable.
• Experience using Guidewire Claims System highly desirable.

Qualifications

• Bachelor’s Degree in a relevant field.
• 3+ years of claims handling experience or equivalent combination of education and experience.

Skills

• Excellent communication and relationship-building skills.
• Composed and calm under pressure.
• Strong negotiation and conflict resolution skills.
• Analytical and investigative skills.
• Natural curiosity and desire to learn more.

Benefits

Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance; retirement plans; work-life balance options; community involvement; wellness programs; and more.