Claims Representative

Claims Representative

The James Allen Companies Inc
Published
August 6, 2019
Location
San Antonio, TX
Category
Claims  
Job Type

Description

Position Summary:
The Claims Representative, Sr. provides key support in the handling of claims across multiple lines of coverage. This includes assessing claim coverage, liability, and legal and damage issues, and investigating, evaluating, and effectively resolving all assigned claims. Substantial independent action is required to resolve complex coverage; along with current claims and jurisdiction knowledge factual and legal issues.

Primary Responsibilities:
• Review, analyze, and interpret policy conditions, exclusions and endorsements to resolve coverage and liability issues for assigned claims
• Prepare reservation of rights letters, nonwaiver agreements, and coverage disclaimers to address claim coverage issues
• Review and evaluate claim reserves to ensure that the respective reserve properly reflects the potential exposure
• Investigate claims to evaluate coverage and legal issues, which may include meeting with Insureds and witnesses, and obtaining statements, records, and other evidentiary materials
• Provide proper documentation and reporting of investigation and claims handling activities
• Negotiates, including through mediation, arbitration, or other court-supervised settlement efforts, settles, and resolves claims with claimants, insureds, and their lawyers; provides appropriate claims resolution documents
• Provides direction to and management of defense counsel, independent adjusters and other third parties retained to assist in a particular claim
• Other duties as assigned

Qualifications:
• Minimum of 5 years of experience with the following:
Coverage Review – interpreting policies, agreements and disclaimers
Claims Investigation – Statements, authorizations, retention of qualified experts and counsel
Claims Administration – Reports, review reserves, knowledge of laws and procedures
Claims Settlement – Preparation of disclaimer letters, releases, and proof of loss statements
• Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service
• Proven ability to develop and maintain good working relationships with customers and co-workers, both internal and external
• Ability to 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
• Good negotiation skills
• Excellent judgment and decision making skills
• Must be able to travel between different off-site locations or overnight in an expeditious manner

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