Claims Representative II (Administrative)

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 or client standards (Inservco).

 

Claims Division: 

Dimension $'s or Numbers Effective Date Accountable for the timely and accurate resolution of assigned claims

Claims:

Manages approximately 1,700 claims per year.  Per claim authority level up to $15K dependent upon, experience and competency

 

Inservco:

Manages approximately 2400 claims per year with an average monetary authority subject to, and dependent upon, experience and competency.

2020

COMPETENCIES AND ESSENTIAL DUTIES

Competency Description of Duties 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 & 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.

Performs other duties as may be assigned by the CSO Team Leader Multi/WC

Claims Service Office Manager II, or CSO Team Leader

CORPORATE CORE COMPETENCIES

Competency Proficiency Description Effectively Communicates and Connects

• Communicates and negotiates effectively with peers regarding work outcomes.
• Influences by making a strong case, bringing other people on the team to understand the presented viewpoint.
• Provides feedback and is clear when disagreeing with an approach; offers suggestions for improvement.
• Attentively listens and asks clarifying questions and paraphrases to enhance understanding.
• Build and nurture positive relationships within the workplace.

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

• 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

Education/

Credentials

• High school diploma or equivalent
• Bachelor's degree preferred
• Adjuster's license or be willing to obtain one as required

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 – 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 required.
• Must be dependable and able to adhere to scheduled work hours