Sr Claims Representative

Sr Claims Representative

The James Allen Companies Inc
Published
July 10, 2018
Location
Category
Claims  
Job Type

Description

Senior Claims Representative

PRINCIPAL JOB RESPONSIBILITIES
With minimal supervision, timely, accurately and efficiently assesses claim coverage, liability, legal and damage issues, investigates, evaluates and, through negotiation, mediation, arbitration litigation, achieves resolution of all assigned claims, including the more complex claims,
maintains good customer relations, maintains good working relations with co-workers and other company personnel. Substantial independent action is required to resolve complex coverage, factual and legal issues. Keeps claims and jurisdictional knowledge current.

DESCRIPTION OF JOB RESPONSIBILITIES
Timely, accurately and efficiently performs the following job responsibilities, plus any other job responsibilities assigned by her or his manager; timely and accurately advises management on matters relating to her or his job responsibilities:

1. Reviews, analyzes and interprets insurance policy conditions, exclusions and
endorsements, to resolve coverage and liability issues for all lines of business;
2. Prepares reservation of rights letters, nonwaiver agreements and coverage disclaimers to address claim coverage issues;
3. Evaluates claim reserves, including periodically evaluating the claim to ensure that the respective reserve properly reflects the potential exposure;
4. Investigates claims to evaluate coverage and legal issues, including meeting with insureds and witnesses, obtaining insured, claimant and witness statements, medical records, experts, defense counsel and other evidentiary materials and information relevant to the respective claim, plus an overall evaluation of each claim, its potential liability and damages and the company's negotiating posture for settlement purposes;
5. Provides documentation of investigation and claims handling activities;
6. Completes company reports for claims files;
7. Negotiates, including through mediation, arbitration or other court-supervised settlement efforts, settles and resolves claims with claimants, insureds and their lawyers;

8. Prepares releases, proof of loss and similar documents as evidence of claims resolution
and authorizes issuance of settlement funds;
9. Provides direction to and management of defense counsel, independent adjusters and
any other third parties retained to assist in a particular claim;
10. Develops, maintains and enhances good customer relations, including participation in the
Branch Business Plan and Agency and Customer Call Programs; 3/14
11. Develops, maintains and enhances good working relations with co-workers and other company personnel with whom contact is necessary to perform her or his job responsibilities;
12. During vacations, or in the absence of the claims supervisor or claims manager, may perform some claims supervisor or claims manager responsibilities;
13. Mentors and helps train less experienced claims representatives; may help supervise some nontechnical tasks and duties;
14. Maintains current knowledge of corporate, claims and jurisdictional environment.

ESSENTIAL JOB FUNCTIONS
Ability to:
1. Create a work product and achieve results that are highly responsive to servicing our
customers' needs and consistent with our company's interest in providing prompt, efficient
and effective claims and customer service;
2. Clearly, accurately and effectively communicate, both orally and in written
correspondence and both internally and externally, including with our customers,
claimants, opposing counsel, defense counsel and members of the public;
3. Develop, maintain and enhance good customer relations with our insureds, agencies and their representatives;
4. Negotiate and be convincing with our customers, claimants, opposing counsel and members of the public;
5. Make judgments about complex factual situations, negotiate settlements and make appropriate decisions regarding all lines, including severe bodily injury claims;
6. Timely and accurately recognize and interpret claims issues as they exist or develop and to make appropriate decisions regarding the coverage at issue;
7. Apply, use and interpret applicable state law cases and statutes regarding liability risks, antifraud requirements, insurance issues and tort and contract law principals involving all lines within the assigned territory;
8. Read, comprehend and interpret insurance policy contracts for all lines regarding coverage, liability and insurance issues and apply those insurance policy contracts to factual claim situations;
9. Apply, use and interpret insurance claims practices for all lines, including specialized industry terminology and medical terms;
10. Comply with applicable fair claims practice statutes and other legal requirements;

11. Comply with company procedures;
12. Work independently and with minimum supervision, including occasionally operating in the field for several days a week;
13. Follow written and oral instructions; 3/14
14. Maintain regular, predictable attendance;
15. Work in a harmonious manner, accept supervision and directions and interact in a cooperative and professional manner with supervisors, co-workers, other company personnel, customers, including insureds and their representatives and other third parties;

16. Timely and accurately organize, prioritize and complete all job responsibilities, including organizational and time-management abilities, without supervision and within assigned deadlines;
17. Maintain a high level of quality work product and output;
18. Efficiently utilize a computer and job related software to perform her or his job responsibilities;
19. Efficiently utilize dictation equipment;
20. Hear, see and talk to effectively communicate, in person and by telephone, with supervisors, co-workers, other company personnel, insureds and their representatives and other third parties;
21. Read and understand written documents, including insurance and policy terms, case law and other factual information;
22. Frequently work on several tasks at the same time with deadlines;
23. Frequently work rapidly and with intense concentration for long periods of time;
24. Frequently travel between different off-site locations or overnight in an expeditious manner;
25. Frequently sit at a desk or other work station for extended periods of time;
26. Occasionally lift and carry equipment and/or materials weighing up to 15 pounds;
27. Routinely bend, kneel, reach, see, be mobile and walk around;
28. Frequently drive an automobile for extended periods of time, doing so in a safe manner;
29. Frequently work outdoors in varying climatic conditions.

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