Manage all aspects of multi-line claims generated by assigned group of agents including claim examination, investigation, determination of coverage, liability, compensability, subrogation, etc., adjustments, litigation and settlements within limit of assigned authority levels. Ensure positive and effective relationships with all assigned agents. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.
Receive claim assignments from assigned agents, verify applicability of coverage.
Determine appropriate methods and extent of needed investigation for all assigned claims and conduct investigation primarily through personal visits and ALS via phone, obtaining medical reports, appraisals, witness and claimant statements/interviews, visual evaluations or other necessary fact-finding methods in order to establish proper coverage, reserves, liability, claim value and disposition. Ensure timely contact times, evaluations, reporting, payments, etc. as outlined in the Claims department service standards.
Ensure proper file documentation and reporting of information secured as result of claim activity.
Ensure rationale for settlement that is consistent with company procedures, reporting standards and guidelines, and may also be responsible for submission of claims forms and reports as required by outside agencies.
Evaluate and adjust claims within limit of assigned authority level. Consult with Claim Manager/Supervisor.
Determine extent of damages, coordinate and establish repair/damage figures. Enter into final settlement negotiations up to a limit of assigned authority levels and participate in litigation process in conjunction with defense counsel when necessary.
Arrange medical examinations, contractors estimates, or other specialists appointments when necessary.
Assess recovery potential. Develop information necessary to successfully pursue recovery.
Act as liaison with attorneys, public adjusters, underwriting department, rehabilitation facilities, investigators or other service vendor as necessary to manage claim including attending trials, arbitration, ADR, conducting face-to-face negotiation.
Assist with monitoring quality of services rendered by appraiser, law firms, structured settlement vendors, rehabilitation vendors, etc. and make recommendations to manager/supervisor.
High School diploma and College degree or equivalent experience with 0-3 years claims experience in related claims handling. Additional required experience:
Excellent PC skills;
Superior verbal and written communication skill;
Strong time management and organizational skills;
Self-starter with ability to work independently;
Valid driver's license in good standing with DMV;
ability to travel and be on-call 24 hours a day; and
Ability to prepare own damage estimates.
Negotiation skills training or other continued education training.
1-2 years appraisal experience.
1 year data entry experience.
*This position requires the attainment of at least one company-approved insurance designation. Refer to the Claims Certification Policy for a list of approved designations and policy details.
CPCU designation/course work, Senior Claims Law course work, or other industry training/designations preferred.
Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.