Senior Claims Representative (Administrative)

The Senior Claims Representative position investigates, evaluates, and disposes of assigned claims in a timely manner in order to achieve best practices type settlements within legal statutes, policy provisions, and Company and/or client guidelines.

COMPETENCIES AND ESSENTIAL DUTIES OF THE SENIOR CLAIMS REPRESENTATIVE 

Business Acumen

• Initiates self-development and training to improve upon, maintain, or acquire skills prescribed as promoting professional and personal growth in claims handling.
• Establishes and maintains a quality relationship with insureds, claimants, agents, underwriting, medical and legal professionals, appraisers, and independent adjusters to develop an effective communication channel through which to more efficiently resolve claims.

Negotiation

• Properly identifies and pursues subrogation, contribution and salvage opportunities when available to reduce or recover the amount of payment.
• Uses appropriate, tactful and complete communications to ease negotiations, develop rapport, and project a positive corporate and personal image.
• The ability to handle claims involving more complex coverage and liability issues; may also require attendance at civil proceedings or workers compensation hearings.

Results Oriented

• Develops claims files from initial assignment to disposition.
• Prepares claim file documentation accurately and completely in order to justify all actions taken and to provide an effective audit trail.
• Achieves a best practices type settlement in the disposition of claims.

Time & Priority Management

• May require outside personal adjusting, interviewing, inspections, scene investigations, and securing of personnel records from clients (pertains to position in Inservco only).

Decision Making

• Completes actions on a timely basis, such as verifying coverages, setting or adjusting reserves, and making appropriate contacts.
• Collaborates with Team Leaders, Managers, and Home Office as necessary to develop case strategy, moving the investigation along and disposing of the claim, in order to keep management, claimants, insureds, and other interested parties satisfied that effective efforts are being made toward claim settlement.

Performs various projects requested or assigned by the reporting managers.

SPECIAL RELATIONSHIPS FOR THE SENIOR CLAIMS REPRESENTATIVE

• This position reports to the Claims Service Manager.
• Direct contact with branch underwriting and/or claims service office personnel
• Direct contact with Home Office claims personnel
• Direct contact with agents, insureds, claimants, medical and legal professionals, appraisers and independent adjusters
• Direct contact with client account personnel

   

QUALIFICATIONS

Education/Credentials

• Continuing education in insurance-related courses such as IIA Certificate in General Insurance, Senior Claims Law Associate, and Associate in Claims courses and/or Workers' Compensation courses (PA 10, 11, 12, and 13) preferred
• Associate's degree in Claims and/or Senior Claims Law Associate designations preferred
• Adjuster's license or be willing to obtain one as required

Experience

• Minimum of 5 years of experience in a property/casualty claims handling position

Technical/Professional Knowledge

• Must have a good understanding of tort and state laws applicable to assigned claims, the Unfair Claims Settlement Act, and insurance policy coverages and provisions
• Must have a good understanding of terminology applicable to assigned claims; i.e., medical, legal, automotive and construction terminology
• Good communication skills, both oral and written
• Good inter-personal skills
• Good negotiation skills
• Good customer service skills
• Good analysis and evaluation skills
• Good decision-making skills
• Must have a strong sense of urgency
• Good PC skills, with an emphasis on Microsoft Office Products
• Good planning and organization skills
• Must be able to work independently as well as a member of a team

JOB REQUIREMENTS (as required by ADA – Americans with Disabilities Act)

• This position is primarily a sedentary position that requires occasional standing and walking throughout the office environment.
• Must be able to see and effectively use a computer monitor.
• Must be able to operate a computer, keyboard and applicable printers and other general office equipment.
• Must be able to access and enter information accurately using automated systems.
• Must be able to hear and communicate via the telephone and/or monitoring devices to both internal and external clients.
• Must be able to present information to individuals and groups.
• Must be able to interpret and apply concepts that may or may not be based upon established guidelines.
• Must be able to maintain acceptable attendance and adhere to scheduled work hours.
• Must have a valid driver's license and be able to operate a motor vehicle.
• Must be able to travel, with overnight stays as required.