Claims Representative - Inside
Investigates, evaluates, negotiates, and resolves assigned property claims having low to moderate complexity and value, working within delegated reserve and settlement authority. Works closely with the Unit Manager, occasionally handling claims with additional complexities related to unique coverage and/or exposure issues.
Essential Duties and Responsibilities:
On a full-fledged or developmental capacity:
- Investigates, evaluates, negotiates, and resolves assigned property claims of low to moderate complexity.
- Determines the facts of the loss, coverage compensability, and the degree of exposure by unit of coverage.
- Reviews, analyzes, and applies policy conditions, provisions, exclusions and endorsements pertinent to a variety of losses.
- Establishes timely and accurate property claim and expense reserves.
- Communicates clearly and professionally with the customer, or their representative, by telephone and/or written correspondence regarding all aspects of the claims process.
- Determines settlement amounts based on independent judgment, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits, and deductibles.
- Negotiates and conveys property claim settlements within authority limits to insureds.
- Controls damage exposures through proper usage of cost containment tools.
- Maintains an effective diary system to ensure timely resolution and documents property claim file activities in accordance with established procedures and state regulations.
- Provides excellent customer service to meet the needs of the insured, agent, and all other internal and external customers.
- Handles files in compliance with state regulations, where applicable.
- Writes denial letters, Reservation of Rights, and other complex correspondence to insureds.
- Identifies property claims that may have value added by an outside field inspection.
- Determines cases that may have fraud potential and refers claims to Special Investigations Unit.
- Identifies potential for subrogation and refers appropriate claims to the Subrogation Unit.
- Partners with counsel to develop litigation plan and adhere to applicable guidelines.
- Performs any other duties as required.
This job description has been prepared to indicate the general nature and level of the work that the employees perform within their classification. This description is not to be interpreted as an inventory of all the duties, tasks, responsibilities and qualifications required for the employees assigned to this job.
Education and / or Experience:
The ideal requirements for the position are listed below, nonetheless, in a developmental capacity, a combination of experience, education, and on-the-job training will be considered adequate.
- Bachelor’s Degree preferred but not required. Minimum of three (3) years of progressive experience in the adjusting of residential and commercial claims or a combination of education and experience.
- Strong verbal and written communications skills.
- Must be able to work in a collaborative atmosphere.
- Must be proficient with Microsoft Office, including Word, Excel, PowerPoint.
- Customer service orientation; empathy.
- Demonstrates ownership attitude and customer centric response to all assigned tasks.
- Solid analytical and decision making skills.
- Spanish speaking a plus.
Licenses and / or Certifications:
- Adjuster’s license(s) (where applicable) required or successfully acquired within 60 days of hiring.
- AIC a plus.
- Professional designation specific to claims a plus.