Claims Representative III - Inside

POSITION CAN BE GAINESVILLE, FL, PALM BEACH, FL or CINCINNATI, OH AREAS

SUMMARY

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. These claims are more complex in nature and involve moderate to severe structural damage.  Investigations are more involved, often relying on consultant, expert opinion and/or use of specialized tradesman to assist with coverage and damage determinations. Claims involve multiple parties (attorneys, public adjusters, contractors) and generally have longer life cycles.

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.

(INVESTIGATION)

• 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.

 (DECISION MAKING)

• 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.

 (COMMUNICATION)

• 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.

(LICENSURE)

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

SUPERVISORY RESPONSIBILITIES

This job has limited supervisory responsibilities.  Claims Representatives may be used to mentor lesser experienced employees and assist with training.  Claims Representatives will communicate expectations to customers and have oversight of all vendors involved in the claim investigation.  

QUALIFICATIONS

To perform this job successfully, an individual must have consistently demonstrated above average performance on several essential job duties.  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. 

EDUCATION AND/OR EXPERIENCE

College degree (four-year college/university) or equivalent professional education and experience combined; Minimum of 4 - 7 years related adjusting experience and successful completion of more advanced level claims training courses and/or insurance industry courses as identified in Claims Training Manual (i.e. Insurance principles, loss adjustment, estimating software, and residential construction).  Completion of advanced job training.

LANGUAGE SKILLS

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.

COMPUTER SKILLS

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.

More advanced proficiency with Symbility or Xactimate estimating software to create/edit estimates while desk adjusting claims.  Ability to write more complex estimates.

MATHEMATICAL SKILLS

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

REASONING ABILITY

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.

BEHAVIORAL STRENGTHS

Good communication and interpersonal skills, customer service oriented, pays attention to detail, shows strong initiative, organizational skills, and empathy and has the ability to learn.  Ability to deal with stressful situations in a professional and non-combative manner.  Can negotiation to help resolve difference within set contractual guidelines.

OTHER RESPONSIBILITIES

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

CERTIFICATES, LICENSES, REGISTRATIONS

Insurance adjusters license State of Florida (520 license).

PHYSICAL DEMANDS

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.

On occasion, an employee should be prepared to work in an outside environment, crawl under homes, and if able, climb on roofs in order to complete inspections.

WORK ENVIRONMENT

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.

TOWER HILL’S TOTAL COMPENSATION PACKAGE INCLUDES:

• Competitive starting salary
• Annual merit reviews and bonus potential
• Medical, Dental, Life and Disability Insurance, and Health Savings Accounts
• Matching 401(k) Plan
• Paid PTO and holidays
• Business casual dress, and more