Summary

The Claims Advocate I will provide clerical/administrative support to department personnel and service claims for existing clients as directed by the Claims Manager. Such servicing will include verbal and written communication internally and externally with clients, insurance company personnel, claims adjusting/administration firms and legal firms.

Essential Duties and Responsibilities Disclaimer:  T

he duties listed are intended to describe the general nature and level of work to be performed.  This is not an exhaustive list of all responsibilities, duties and skills which may be required. 

40%  Client Services

Responsibilities include:

• Maintaining direct communication and building relationships with insureds.
• Processing initial information on claims over the telephone, including first reports of loss.
• Reporting losses to companies with diary follow-ups. 
• Acting as intermediary to negotiate settlements between company and insured. 
• Reviews loss scenarios and advises insureds on possible coverage and premium impact. 
• Assisting in settling claims
• Establishing and maintaining active claim files to include diary and suspense monitoring and follow-ups. 
• Assisting in file audits.

40%  Policy Services

Responsibilities include:

• Processing all mail for claims. 
• Performing administrative functions, including but not limited to correspondence, reports, and other documents as needed.
• Maintaining claims dead files.
• Building relationship with insurance carriers. 
• Maintaining compliance with all Claims service standards and procedures.
• Developing Producer and Claims Manager confidence in job knowledge, judgment calls, and awareness of current industry trends and developments.
• Handling complex policy issues and finding resolution with minimal Producer/Service Manager involvement.

10%  Teamwork

Works together with team and with other departments; this includes discussing execution strategies with Producers/Claims Manager.   Assists in training of new service team members.  Volunteers to back up and/or assist others as needed.  Special project as requested by Manager.  Manages PTO to work with departmental needs.

10%  Determination

Displays commitment and initiative to meet department and agency education goals as set forth in the organizations education program. 

Supervisory Responsibilities

Directly supervises 1-2 Claims Assistants. Responsibilities include assigning, and directing work to Assistants.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:  Analytical - Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data.  Continuous Learning - Assesses own strengths and weaknesses; seeks feedback to improve performance; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.  Job Knowledge - Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; keeps abreast of current developments; requires minimal supervision; displays understanding of how job relates to others; uses resources effectively.  Use of Technology - Demonstrates required skills; adapts to new technologies; troubleshoots technological problems; uses technology to increase productivity; keeps technical skills up to date.  Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.  Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance; meets commitments.  Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods.  Cooperation - Establishes and maintains effective relations; exhibits tact and consideration; offers assistance and support to co-workers; works cooperatively in group situations; works actively to resolve conflicts.  Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.  Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.  Written Communication - Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.  Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.  Organizational Support - Follows policies and procedures.  Adaptability - Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.  Achievement Focus - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence; recognizes and acts on opportunities.  Personal Appearance - Dresses appropriately for position; keeps self well groomed.  Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time.  Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals.; completes tasks on time or notifies appropriate person with an alternate plan.  Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities; asks for and offers help when needed.  Planning/Organizing - Prioritizes and plans work activities; uses time efficiently.  Quality - Demonstrates accuracy and thoroughness; monitors own work to ensure quality.

Qualifications

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.

Education and/or Experience

At least three years related insurance experience and/or training, preferably handling multi-line, large commercial claims; or equivalent combination of education and experience.

Language Skills

Ability to read, analyze, and interpret complex documents, such as insurance policies.  Ability to respond effectively to inquiries or service issues from company personnel and/or clients.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. 

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to bring full resolution to issues with minimal Producer /Service Manager involvement. 

Computer Skills

To perform this job successfully, an individual should have knowledge of  Database software;  Internet software;  Spreadsheet software and  Word Processing software.

Certificates, Licenses, Registrations

Must hold applicable state insurance license or have the ability to obtain such within 90 days of employment.  Must be able to obtain insurance designations as set forth by the organization’s education plan. 

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; use hands to finger, handle, or feel; reach with hands and arms and talk or hear.  The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision and ability to adjust focus.

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.