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Total Loss Telephone Claims Rep I,Ii, Sr.

Expired Job

National General Phoenix , AZ 85002

Posted 5 months ago

Job Description:

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.

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

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Total Loss Telephone Claims Rep I,Ii, Sr.

Expired Job

National General