Claims Representative II

The Claims Representative II investigates, evaluates and resolves assigned claims in a timely and accurate manner in order to achieve a best practices type settlement within legal statutes, policy provisions and Company standards of performance.

ESSENTIAL DUTIES AND RESPONSIBILITIES OF THE CLAIMS REPRESENTATIVE II

Business Acumen:

Prepares claim file documentation accurately and completely, to include all relevant oral and written statements, photos, facts and environmental factors present at the scene of the accident.

Negotiation :

Makes appropriate contacts and negotiating with policyholders, claimants, third parties, medical and legal professionals in the processes of arbitration, litigation, subrogation, contribution and salvage.

Achieves a best practices type settlement in the disposition of assigned claims, to include:

• assessing all costs and determining first and third party liabilities associated with the settlement of auto property damage, non-complex workers’ compensation, property losses and simple bodily injury claims.
  

Results Oriented:

Effectively identifies and pursues subrogation and salvage opportunities, when available.

Time and Priority Management:

Performs basic and intermediate claims handling duties on assigned claims in a timely manner.

Verifies coverage and policy provisions in order to identify the claim’s insurability or compensability.

Takes responsibility for handling and resolving policyholder/self-insured/claimant problems or requests.

At the direction of the Team Leader, may perform limited field work, limited claim handling on workers’ compensation lost time claims of low exposure/low complexity, as well as low exposure/low complexity bodily injury liability claims.

Decision Making:

Analyzes and resolves coverage and liability issues or questions.

Gathers and evaluates factual information that enhances identification of underlying problems or opportunities pertaining to assigned claims.

Generates alternative solutions to problems or situations involving assigned claims.

Setting or adjusting reserves in accordance with the degree of liability and value of the claim.

CORPORATE CORE COMPETENCIES OF THE CLAIMS REPRESENTATIVE II

Customer Focused:

Identifies explicit and implied customer needs .

Asks probing questions to fully understand business requirements.

Develops positive relationships with customers by meeting their needs as well as incorporating their feedback.

Responds quickly and takes action with high quality solutions that address needs and improve overall customer experience.

Owns resolution of customer experience outcome.

Talent Development Mindset:

Discuss technical and professional development with peers to gain suggestions for further development.

Actively seek and act on opportunities to recognize peers for high performance.

Stays alert to identify learning opportunities for self.

Demonstrates Adaptability:

Contributes to progressive thinking within the team by posing questions that challenge traditional methods or processes.

Proposes ideas and suggests new approaches to tackling own work tasks and issues in a better way to drive organization success.

Participate in and actively support change initiatives, and provide ideas to promote their success.

Recognizes and manages an ambiguous work environment.

Demonstrates flexibility in generating alternative solutions and recommendations.

Demonstrates Accountability:

Applies judgment in making decisions about own work, and takes responsibility for actions.

Demonstrates reliability by producing steady work results and delivering on commitments to team members on time.

Takes responsibility for regularly seeking and applying feedback and actively learning from errors and setbacks.

Understands the mission of the organization.

SPECIAL RELATIONSHIPS FOR THE CLAIMS REPRESENTATIVE II

The Claims Representative II reports to the assigned CSO Team Leader Multi/WC, Claims Service Office Manager II, or CSO Team Leader

The Claims Representative II has direct contact and interacts with all levels of personnel within the Claims Service Office

Occasionally interacts with underwriting personnel regarding claim issues

May occasionally interact with agents

Has direct contact with policyholders/claimants, third parties, medical/legal professionals, vendors

QUALIFICATIONS FOR THE CLAIMS REPRESENTATIVE II

Education/Credentials:

High school diploma or equivalent

Bachelor's degree preferred

Experience:

Successful completion of Claims Representative II Trainee curriculum or a minimum of 1 year experience in a property/casualty claims handling position.

Technical/Professional Knowledge:

Effective communication skills, both oral and written

Effective inter-personal skills

Effective organization skills, with the ability to work independently

Must be detail oriented, as assigned work requires significant attention to detail

Personal Computer skills, with an emphasis on Microsoft products

Ability to work within a team-oriented, fast-paced, customer-focused environment

Basic understanding of tort and state laws applicable to assigned claims

Basic understanding of the Unfair Claims Settlement Practices Act, insurance policy coverages and provisions, and medical, legal, automotive and construction terminology

JOB REQUIREMENTS (as required by ADA)

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 required.

Must be dependable and able to adhere to scheduled work hours