Claims Representative - High Risk Unit - HYBRID
The High Risk Unit investigates and mitigates high risk and complex property damage based on coverage risk factors and exposures. The Claims, HRU representative role involves identifying potential premium avoidance, indications of fraud within high frequency/severity losses, and reporting suspicious claims to Underwriting and SIU as they are identified. The unit handles claims primary focused on the Massachusetts Personal Auto Policy but also received claims involving Commercial Auto.
- Investigates new claims; completes preliminary investigation and any complex coverage and liability issues associated with the policy.
- Initiates contact and receives and processes statements from insured’s, operators, witnesses and other parties related to accidents.
- Responds to all legal complaints and/or demands and intercompany arbitrations.
- Reviews appraisals, medical bills, police reports and location photographs to determine if the damages and injuries are consistent with the facts of the loss as reported by the insured to determine if claim should be paid.
- Uses independent judgment and discretion in determining whether field assist or SIU adjusters are appropriate to involve in the investigation.
- Manages claim process, maintains detailed records and statements, returns phone calls and e-mails, ensure regulatory compliance standards are met.
- Negotiates claim settlements; involve counsel as necessary to respond to complaints, summons and litigation processes.
- Some prior claim experience required
- Knowledge of the underwriting process and The MA Auto Policy and its exceptions/exclusions
- Familiarity with identifying casualty exposures
- Motivated, success driven individual with demonstrated high proficiency in a prior claims adjusting role
- The optimal candidate would have a focus on attention to detail and strong critical thinking skills
- 4 weeks Accrued Paid Time off/ 9 paid national holidays
- Robust Wellness Program
- 401(k) Bonus
- Tuition Reimbursement
- Auto and Home Insurance Discounts
- Volunteer Opportunities
- Company-Paid Life and Disability Insurance Plans
- Optional Medical, Dental, Vision, Legal, and Identity Theft Protection Plans
About the Company
The Plymouth Rock Company and its affiliated group of companies write and manage over $1.7 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 2,000 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
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