Bodily Injury Telephone Claims Representative
Primary Purpose: Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. Claims involved are usually subject to standardized procedures which lead to a settlement with limited exercise of discretion. Claims involved occasionally require analysis and may require research to resolve coverage and/or damage issues. There is supervisory review of ongoing progress and results of work. There is more focused supervision on all complex files. >> This posting is for Washington State Essential Duties and Responsibilities: Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. * Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability * Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary * Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval * Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option * Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement * Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion * May handle more complex files with appropriate supervision to develop skills * Develop a working knowledge of systems and technology used within the company * Identify customer needs and work to meet those needs using appropriate customer service skills Required Skills and Competencies: 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. * Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience * Successfully completes Claim Representative trainee program, or equivalent external training program * Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint) * Obtain/Maintain appropriate licensing or educational requirements * Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500 * Demonstrate proficiency in file audits to agreed standard of efficient claims quality * Has a basic command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor * Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files * For claims involving material damage, comply with the company material damage guidelines * Can handle most types of comprehensive losses (theft, fire, and vandalism), accurately identify total losses * For claims involving injuries, have a general understanding of how to review, evaluate, and negotiate injury claims * High degree of initiative, mature judgment, and discretion * Ability to resolve conflicts and empathize with customers is critical * Strong negotiation skills * Demonstrate professional oral and written communication skills * Organization a To view the full job description, click here Company Information !*!*! Use Pre-Filled Information !*!*!