Claims Representative I

Dallas, Texas
Oct 10, 2016
Dec 09, 2016
Job Type
Not Specified
Career Level
Not Specified

Qeo Claims Representative I – Job Description

General Description:

The Claims Representative I (CR-I) uses their claims handling knowledge and experience to investigate, evaluate, negotiate, settle and/or resolve all aspects of small to moderate complexity first and third party commercial auto claims, including all property damages and bodily injuries. The CR-I will handle various claims arising across multiple jurisdictions, and their claims handling is expected to comply with all applicable laws and regulations, as well as to comply with Qeo’s internal claims handling guidelines, policies and procedures. This position could include some responsibility for the training, mentoring and development of new claims associates of equivalent or lesser experience levels. The CR-I will be responsible for developing strategic action plans for each claim handled, in order to provide an outline to resolve the claims as quickly as possible.

Primary responsibilities:

  • Initial coverage verification and coverage reviews of all claims presented.
  • Timely contact and investigation of all claims filed by Qeo policyholders and claimants.
  • Interview/take statements from insureds, claimants, witnesses and other pertinent parties to gather necessary information to evaluate the claims.
  • Handle and process a variety of commercial auto liability claims types including first and third party PD and BI (CSL, PIP, Medpay, UM/UIM, auto phys dam, etc.).
  • Make assignments to designated field personnel and/or claims vendors as appropriate.
  • Evaluate claim facts in tandem with the applicable coverages and jurisdictional tort laws in order to make an assessment of the liability of all involved parties.
  • Evaluate damages to ascertain amounts payable (if any) to involved parties.
  • Obtain and review police reports, BI indexes, medical records and bills, wage loss statements, etc.
  • Examine photographs, estimates, appraisals, invoices, I.A. reports, etc.
  • Identify fraud indicators and notify Qeo’s SIU Department as appropriate.
  • Evaluate all information received to determine how claim should be further handled.
  • Negotiate with policyholders and claimants to settle the claims as quickly as possible.
  • Achieve timely and optimal claims handling results. Claims handled at this level should be resolved and closed very quickly.
  • Timely and accurately reserve all suffixes within prescribed authority levels.
  • Provide system and technical training to new associates.

Knowledge, Skills and Experience Required:

  • Bachelor’s Degree Preferred.
  • One year minimum prior experience as an inside staff or independent adjuster
  • Excellent organizational skills including the ability to multi-task and prioritize duties
  • Excellent communication skills (both oral and written)
  • Exceptional customer service skills
  • Proficient in basic computer skills