SENIOR MULTI LINE CLAIMS REPRESENTATIVE

Essential Functions

• Determines coverage and investigates claims: Makes personal, written, or telephone contact with general public, reporting agencies, and suppliers of services/goods.
• Reviews and interprets policies to determine coverage. Reviews records and documentation.
• Takes telephone-recorded statements from insureds, claimants, and witnesses involved. Determines liability. Determines amount of loss/damage. Makes assignments to appraisers or independent adjusters as needed.
• Orders police reports. Indexes injured insured and claimants; follows Medicare reporting requirements and files PLR.
• Assigns independent adjusters; independent appraisers; and experts to assist in the investigation and evaluation of the claim. Utilizes counsel to assist in coverage and / or investigation of claims.
• Determines settlement values: Utilizes information gained from claim investigations, applicable regulations, and policy provisions or limits.
• Reviews reserves: Reviews reserves on a 30-day basis. Modifies as necessary, within established authority, or seeks appropriate approvals.
• Develops and documents claims files. Establishes and maintains a 30-day diary to updated file handling.
• Negotiates with insureds, claimants, or legal representatives; settles claims promptly, fairly, and within established authority.
• Issues claim and expense payments. Secures appropriate approvals for check requisition on claims exceeding authority.
• Pursues other carriers for subrogation and determines percent of liability (non-auto claims).
• Handles non-auto salvage.
• Ensures compliance with the Unfair Claim Practices Act and Good Faith Claim Handling regulation.
• Participates in claim orientation for Underwriting personnel, helping with analysis of coverage and/or claim situations.

Qualifications/Basic Job Requirements

• Bachelor’s degree or equivalent education and experience combination
• Proficient interpersonal relations and communications skills (both written and verbal)
• Thorough knowledge of claims law
• Proficient analytical and problem solving skills
• Capacity to work well independently
• Moderate computer knowledge
• Demonstrated organizational and time management abilities
• Demonstrated abilities to deal with a variety of personalities
• Minimum of five years’ experience with investigation, management, and negotiation of liability and property claims in states of operation