Claims Specialist

Claims Specialist

A Claim Specialist works independently or with minimal direction, managing claims that present high exposure and / or complex coverage or liability issues for all lines of business : Homeowners, Personal Auto, Commercial Auto, GarageKeeper, Commercial Liability and Farm Liability.

Salary Grade (13) 76,101 - 97,030 - 117,958

Determines coverage, liability, sets and adjusts reserves, evaluates the claim, manages the litigation and negotiates settlements. Works within prescribed authority limits handling claims. Investigate and determine liability of all parties involved. Ensures delivery of high-quality customer service to protect our insured, and assets of the company. Demonstrates a high level of expertise and sound judgment in complex matters; may serve as a subject matter expert. Required to manage assigned caseload of casualty losses in accordance with Company standards and IC 27-4-1 / ORC 3901-1-54.

The 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.

• Coverage / Investigation / Liability - Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness.
• Damages - Determines the value of the physical damage of property, automobiles, or injuries through physical inspections and use of appropriate tools. Obtains all necessary documentation to support claim evaluation. Recognizes claim file exposures and escalates appropriately.
• Reserving / Reporting - Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. Completes appropriate reports so that the status of the claim is clearly documented at all times.
• Determines need for, and engages independent adjusters, cause and origin experts, independent medical examiners or other experts (e.g. reconstructionist, engineer).
• Proficiently and proactively handle the claim file through various phases of litigation. Independently review the applicability of coverage and civil law as well as local statutes. Attend mandatory and court ordered litigation events : mediation, pre-trial, trial.
• Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to coverage, liability and damages. May analyze the impact upon claims policies and procedures and advises Claims Management. Participates in or leads special projects and mentors others, as needed.
• Initiate prompt and effective communication with all parties having legal or contractual interest in claim presented
• Capable of drafting clear and concise letters and other correspondence.
• Accountable for security of financial processing of claims, as well as security information contained in claims files.
• Confers directly with policyholders on coverage and resolution issues pursuant to Home Office instructions.
• Prepare claims for trial, comply with trial alert procedures and notify / update reinsurance when appropriate.
• Participate in training programs, conferences and departmental and intra-departmental meetings.
• May be required to be on-call, on a limited basis, for afterhours emergencies
• Any other duties deemed necessary by supervisor or management.

None

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.

College Degree or Equivalent Experience

At Least 3 years as a Sr. Claim Representative or equivalent preferred

Excellent Written and Verbal Communication Skills

Excellent Interpersonal Skills

Superior Organizational Skills

Efficient Time Management skills

Ability to Demonstrate effective negotiation skills

Excellent verbal and written communication skills. The individual must be able to effectively and clearly communicate with agents, insureds, departmental and company personnel via telephone, fax, e-mail, one-on-one dialogue and small group presentations in a professional manner.

The position requires the individual to apply common sense, understanding, reasoning and sound educated judgement coupled with sound Claims training and experience to properly evaluate and analyze claims for recommended action within assigned authority levels.

IIA, AIC, or CPCU are highly preferred

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.

Employees are required to sit at a workstation to perform various PC functions. Additionally, the employee is required to devote substantial time to telephone communication.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms.

Employees may be required to travel from time to time. This may require extended periods of time sitting in a vehicle.

The Claim Specialist is responsible for the proper handling of claims. Each Claim Specialist will be assigned a specific work cubicle station and or other individual work areas. The workstation will be located adjacent to other similar workstations. The workstation has the necessary equipment to perform the position duties including personal computer, telephone, file space, and needed work table space.

The environment is reasonably quiet with needed interaction between other team members, immediate supervisor, and other Company staff. Moderate noise level from telephone calls is expected.