Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigations, damages development, evaluations, reserving, litigation management, and disposition.
Provides voice to voice contact within 24 hours of first report.
Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
Investigates each claim through prompt contact with appropriate parties such as policyholders, Association managers, Board of Directors, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings.
Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establish proper indemnity and expense reserves, at required time intervals,
Utilizes evaluation documentation tools in accordance with department guidelines.
Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
Negotiates disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
Manages litigated claims as assigned. Develops litigation plan with staff or panel counsel, track and control legal expenses. Assures cost-effective resolution.
Maintains claim files, has an effective diary system, and documents claim file activities in accordance with established procedures.
Attends depositions, EUOs, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Protects organization's value by keeping information confidential.
Maintains compliance with Claim Department's Best Practices.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws
Provide quality customer service and ensure file quality.
Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
Participates in special projects as assigned.
Some overnight travel maybe required.
Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.
Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
620 Licensure required.
2-3 years of experience processing claims; property and casualty segment preferred.
Experience with Xactware products preferred.
Flexibility to work nontraditional hours.
Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
Proficiency with Microsoft Office products required; internet research tools preferred.
Demonstrated customer service focus / superior customer service skills.
Excellent communication skills and ability to interact on a professional level with internal and external personnel
Results driven with strong problem solving and analytical skills.
Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
Detail-oriented and exceptionally organized
Collaborative partner; ability to contribute to a positive work environment.
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