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Years of Experience
Date Last Verified
ProfileClaim Associate Under close supervision, the candidate will receive assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business. Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal. Evaluate facts supplied by investigation to determine extent of liability of the insured, if any, and extent of the company’s obligation to the insured under the policy contract. Prepare reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Set reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Supervisor and discusses problems and suggested remedial actions. Prepares and submits to Supervisor unusual or possible undesirable exposures. Assist Supervisor in developing methods and improvements for handling claims. Settle claims promptly and equitably. Obtain releases, proofs of loss or compensation agreements and issues company drafts in payments for claims. Inform claimants, insureds/customers or attorney of denial of claim when applicable. Process internal claim from first report to final resolution. Ensure that each claim file is properly documented to support the claim payment or denial. Maintain a timely follow up for all pending claim request. Keep an updated inventory log of all new mail, pending claims, paid and denied claims. Maintain claim payments within the Fair Claim Practice Acts to ensure compliance. Completed pending claim file ups every 30 days and document files accordingly. Make sure that appropriate Work View files are created that contain all claim related items for audit purposes. Ensure that claims are paid accurately and in accordance to the policy provision. Ensure that all claims in excess of your authority have been reviewed and approved by either the department head or one of the Claim Directors. Complete all CLR’s as required for any payment in excess of $500,000 gross amount. Communicates approved claims to the appropriate persons. Work with the underwriters on policy questions and policy clarification. Provide customer service to the policyholders, claimants, underwriters, brokers and agents on direct handled claims. Participate with the underwriters and sales force on the completion of all claim related RFP’s and work on new claim account set-up procedures and meetings. Respond quickly and appropriately to all internal and external telephone and written inquiries and requests for information. Be proactive in communication with internal and external business partners. Bachelor’s/Master’s/ or JD degree or equivalent experience required. Bachelor’s degree in many majors will be considered, with a slight preference to Risk Management or Business majors required. JD, Master’s degree, or equivalent experience preferred. Some knowledge of insurance concepts, practices, and procedures is desirable. MS Office experience, including Word, Excel, and Outlook required. Oral and written communication skills, negotiation skills required. Strong Communication Skills - including the ability to listen effectively; to confidently and diplomatically express opinions and voice concerns with other team members required.
Job Number: 314935