Field Claims Representative II

Field Claims Representative II

The James Allen Companies Inc
Published
November 14, 2018
Location
Madison, WI
Category
Claims  
Job Type

Description

Field Claims Representative II
This position is primarily focused on handling commercial liability claims in the Madison, WI area.

Primary Purpose

With minimal manager guidance, resolves moderate-to-severe claims on multiple lines of coverage by performing field investigations; determining and documenting losses; negotiating out-of-court settlements in accordance with departmental and company guidelines and standards.

Essential Functions and Responsibilities

(Other duties may be assigned)

  • Settles moderate to severe claims by determining insurance carrier’s liability; reaching agreement with claimant according to policy provisions and authority level; handling mediations, arbitrations, and subrogation within authority level.

  • Determines coverage by meeting with insureds; securing evidence; inspecting losses; investigating incidents; interpreting policy coverages; explaining coverages; determining subrogation and salvage.

  • Documents required repairs by scoping property losses; hiring necessary experts; obtaining costs and prices; preparing estimates; reviewing business interruption exposures.

  • Develops and maintains expertise in a specified line(s) of business.

  • Mentors and trains claims representatives in area(s) of claims expertise by assisting in identifying training needs and opportunities; assists in the development of training programs in areas of claims expertise.

  • May be involved with litigation by analyzing negotiated settlement options; evaluating evidence; and overseeing attorneys in the handling of discovery and settlement.

  • Completes claims by obtaining, providing, and exchanging information and agreements with contractors, attorneys, health care providers and other third parties.

  • Prepares reports by collecting, analyzing, and summarizing claim information.

  • Completes scene investigations completely and promptly.

  • Resolves questionable claims through investigations; comparing claims information with evidence.

  • Provides claims information by documenting claims transactions of assigned files in compliance with company and state requirements; preparing loss development reports.

  • Maintains home office by organizing office operations and procedures; controlling correspondence; designing filing systems; performing clerical functions; preparing and filing documents.

  • Contributes to team effort by participating on catastrophe teams.

  • Assists home office claim representatives on claims in assigned coverage territories.

  • Ensures company guidelines and procedures are followed by overseeing independent adjusters during investigations; overseeing attorneys in the handling of discovery and settlement.

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, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required:

  • Bachelor’s degree and at least 5 years of claims handling experience.

    OR

    At least 7 years of field claims handling experience involving the exercise of discretionary decision-making and increasing levels of severity including specialized coverages and loss adjustments as determined by Company.

  • Technical proficiency in commercial property and/or casualty claims demonstrated through knowledge and experience in insurance policies and coverage; claim payment procedures; insurance regulations and legal terminology.

  • Familiarity with PC applications including word processing, Internet, spreadsheets and e-mail software.

  • Valid driver’s license and a satisfactory driving record as determined by Company.

Preferred:

  • Bachelor’s degree in business or related field and at least 5 years of claims handling experience.

  • Professional designations of AIC, ARM, CIC, CPCU or equivalent coursework.

  • Knowledge of building components, pricing, and medical terminology.

  • Familiarity with estimating software.

  • Proficient investigative skills demonstrated through experience.

Working Conditions and Environment

  • Exposure to weather (hot, cold, wet, humid, or windy).

  • Fire and large property scenes involving catastrophe losses may have hazards and difficult conditions including no electrical power, debris, emergency vehicles and staff.

  • Presence at fire scenes and storm losses lend to extensive noise, fumes, and odors.

  • Regular travel is required; frequent overnight stays may also be required.

  • At times unusual work hours may be required.

Physical Demands

  • Climbing (i.e. ladder to access roof).

  • Long periods of standing.

  • Light (up to10 lbs.) lifting occurs frequently.

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