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Claim Representative II

Capital Insurance Group. Westlake Village, CA Full-Time
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JOB OVERVIEW:

The primary purpose of a Claim Representative is to investigate, evaluate, and resolve commercial and personal lines 3rd party casualty claims. Demonstrates superior claim service and produces appropriate claim settlements. It is incumbent upon this individual to understand regulations and the jurisdiction(s) involved in the claims being evaluated.

RESPONSIBILITIES:

  • Responsible for the investigation, evaluation, adjustment and resolution of assigned Claims within designated territory.

  • Able to communicate effectively with policyholders and their representatives.

  • Ability to draft complex coverage letters and provide effective direction to assigned claim service vendors/experts.

  • Must assure quality compliance with applicable insurance regulations and statutes.

  • Maintain a high level of file quality based on DOI regulations and CIG claim standards.

  • Accountable for handling claims within assigned monetary authority and may handle claims exceeding monetary authority under the supervision of management with the requisite authority.

  • Responsible for field investigations and adjusting.

MINIMUM REQUIREMENTS:

  • Bachelor’s degree or equivalent experience, and two to five years of claims handling experience.

  • Advanced technical training in insurance claim field and/or AIC designation is preferred.

  • Must have expertise and detailed knowledge of Commercial, Personal Lines, and Inland Marine policy language and coverages.

  • Mathematically proficient with the ability to comprehend charts and graphs.

  • Experienced with structural estimate accuracy and review.

  • Proven ability to comprehend complex contracts, technical journals pertaining to Insurance claim laws and regulations.

  • Ability to multi-task and deal with numerous complex problems or issues simultaneously.

  • Must be able to travel within assigned territory and maintain a valid driver’s license.

  • Ability to work in a virtual environment with no physical direct supervision.

 

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Claims
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Job ID: 782

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