Inside Claims Representative I

Position Summary

Under close supervision, handles liability and property claims within designated authority. Resolves coverage and/or liability issues in accordance with applicable state insurance laws, regulations, and procedures.

Duties and Responsibilities

• Investigates and adjudicates claims within designated authority, ensuring compliance with appropriate statutory laws. Verifies coverage, establishes and maintains reserves, secures recorded statements, drafts and processes correspondence, reports and records. Obtains additional information as required to determine liability. Documents claim files and facilitates processing of claims in collaboration with other departments. Assigns outside experts when necessary to assist in investigation and in support of potential recovery.
• Evaluates and negotiates claims, recognizes subrogation opportunities, and initiates action. Sets up and/or issues payment using ERIE’s approved payment methods for settlement; or declines payment within designated authority.
• Responds to inquiries from Policyholders, Agents, insurance carriers, claimants, assigned experts and others.
• Learns and maintains knowledge of liability laws for each state. Learns and maintains knowledge of motor vehicle codes.
• Learns and maintains knowledge of no fault/medical management/FPB laws for each state, including recognition of bodily injury claims.
• With supervisor guidance, responds to intercompany arbitration applications. Files contentions and supporting documents on behalf of the insured/driver.
• Conducts research, attends industry-related training programs and other training sessions to stay current on policy changes, interpretation, or new legislation.
• Provides support for property claims during periods of heavy volume.

Qualifications

• Minimum Educational and Experience Requirements: High school diploma or GED and two years of related claims handling or customer service experience, or equivalent educational experience required. Bachelor’s or Associate’s degree preferred.
• Designations and/or Licenses: Successful completion of Introduction to Insurance (INTRO) and Introduction to Claims (AIC 30) preferred. Obtain appropriate licenses as required by state within 45 days of employment in the role for external applicants and 90 days of employment in the role for internal applicants.

Physical Requirements

• Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)
• Climbing/accessing heights; Rarely
• Ability to move over 50 lbs using lifting aide equipment; Rarely
• Driving; Never
• Lifting/Moving 0-20 lbs; Rarely
• Lifting/Moving 20-50 lbs; Rarely
• Pushing/Pulling/moving objects, equipment with wheels; Rarely