Claims Representative II - Inside

Job Title:                   Representative II, Inside Claims

Department:             Claims

Reports To:               Manager, Claims

FLSA Status:             Exempt

Revised By:               Lisa Barlow/ Leslie Potteiger

Revision Date:          11/5/2015


Review and analyze routine first party homeowner’s claims to determine extent of insurance carrier’s liability, determines the extent of damaged property, and recommends settlement amounts in order conclude claims with policyholders in accordance with policy provisions and applicable insurance statutes and laws.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.  Other duties may be assigned.

Reviews the insurance policy, endorsements, and related information in order to make a coverage determination.


  • Conducts the appropriate claim investigation and directs the investigation of any assigned resources.
  • Obtains any physical evidence, develops third party information and theory of liability, conducts recorded interviews, and secures official records.
  • Recognizes and submits subrogation, underwriting and SIU referrals as necessary.
  • Maintains file documentation, file notes and investigation documentation on each assigned claim in accordance with company guidelines.


  • Reviews policy, adjusters’ reports, damage estimates, expert reports and any other documentation needed to make the appropriate coverage and loss decisions to conclude assigned claims.
  • Able to write/create/edit estimates based on customer’s information or independent adjuster’s information utilizing computerized estimating system.
  • Able to write/create/edit letter to confirm status or decision.
  • Makes recommendations and decisions based on claim documentation and investigation.


  • Provides prompt service to policyholders utilizing phone, fax, mail and electronic mail. Communicates with all customers in a professional manner.
  • Complies with customer service objectives (as determined by the company)
  • Communicates with Claims Supervisors consistent with company guidelines.


  • Successfully completes training and maintains FL License by meeting Continuing Education requirements.
  • Operates in accordance with Florida Statues


This job has no supervisory responsibilities; however, Claims Representatives will communicate expectations and oversee all vendors involved in the claim investigation.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


College degree (four-year college/university) or equivalent professional education and experience combined; and a minimum of 1-3 years professional experience; successful completion of our initial training program consisting of insurance principles, loss adjustment basics and basic residential construction.  In addition, candidates should complete training as identified in Claims Training Manual (i.e. minimum of 2 additional construction/restoration related classes and Symbility training).


Knowledge of personal line property forms, ability to read and interpret documents such as insurance contracts, structural estimates, expert reports, construction codes, safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively in person and on the telephone.


Proficient with the Microsoft Office Suite including, Word, Excel, and Power Point.  Individual must be able to create presentations using Power Point and other available software and equipment.  Basic working knowledge of Symbility or Xactimate estimating software.


Computer and computer program utilization, ability to calculate figures and amounts, such as, square footage, linear feet, overhead and profit, sales tax, actual cash value, interest, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.


Ability to define problems, collects data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.


Good communication and interpersonal skills, customer service oriented, empathy, pays attention to detail, shows strong initiative, organizational skills, and has the ability to learn.  Ability to deal at times with stressful situations in a professional and non-combative manner.


  • Provide support to other members of the technical claims staff.
  • Participates in CAT Duty as required.
  • Other duties as determined by management.


Insurance adjusters license State of Florida (520 license).


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle or feel.  The employee frequently is required to reach with hands and arms.  The employee is occasionally required to stand; walk; stoop, kneel, crouch, or craw; and talk or hear.  The employee must occasionally lift and/or move up to 30 pounds.  Specific vision abilities required by this job include close vision, color vision, peripheral vision and ability to adjust focus.


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.



No matter the square footage, your home is your castle. At Tower Hill we’re in the business of protecting castles. We provide the insurance protection you need and the peace of mind you want.

Founded more than 40 years ago, today Tower Hill is Florida’s largest homeowners insurer. Our company is financially strong and solid. We’ve weathered every storm and natural disaster in the state since 1972, and helped our customers rebuild after each one.

Like you, we love Florida. We enjoy the sun when it’s shining, appreciate mild winters, watch out for lightning, and build hurricane kits every summer. And like you, our homes are our castles. Sometimes the unexpected happens — or even the unthinkable — and we understand what that feels like, too. That’s why our 400 employees are committed to being there when you need us all year long, not just during storm season.

Your home is where you and your family should feel safe and protected. You can be confident that if the unthinkable happens, Tower Hill will be there to help you rebuild. When your home truly feels like your castle again to you, we know we’ve succeeded as your insurance company. Although we have grown in size over the last four decades, we remain committed to the promises we made when our company was founded.