JOB DESCRIPTION
Essential Duties & Responsibilities :
Performs a combination of duties in accordance with departmental guidelines :
- Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit.
- Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
- Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols.
- Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim.
- Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes.
- Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
- Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
- Identifies and addresses subrogation / salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation.
- Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
- Maintains compliance with state / local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
- Developing basic knowledge of the commercial insurance industry, products and claim practices.
- Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service.
- Ability to develop collaborative business relationships with both internal and external work partners.
- Able to exercise independent judgement, solve basic problems and make sound business decisions.
- Analytical mindset with critical thinking skills.
- Strong work ethic, with demonstrated time management and organizational skills.
- Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
- Knowledge of Microsoft Office Suite and ability to learn business-related software.
- Adaptable to a changing environment
- Ability to value diverse opinions and ideas
Education & Experience :
- High school Diploma required. Associates or Bachelor's Degree preferred.
- Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
- Prior claim handling, or business experience in the insurance industry and / or customer service is preferred.
Claims Representative, APD
Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. Developing ability to manage expenses ...
Customer Service Representative - Manufacturing
This role involves handling inquiries, processi Customer Service Representative, Customer Service, Manufacturing, Representative, Retail, Staffing. The Customer Service Representative will be the first point of contact for our customers, providing exceptional service and support throughout their exp...
Customer Service Representative
The Customer Service Representative is responsible for managing customer accounts through reactive and proactive telephone contact and email to maintain and grow sales. Customer Service Representative (CSR). Perform, execute, and coordinate all work including technical matters related to customer se...
Experienced Claims Adjuster
Please note: This position requires direct experience adjudicating medical claims. Examining, processing, calculating and adjudicating claims in compliance to plan documentation. Following daily direction to process high dollar claims and other priorities/issues listed on the daily reports that are ...
Claims Representative, APD
Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. Developing ability to manage expenses ...
Customer Service Representative
As a Customer Service Representative, you are a key team member in upholding our commitment to customer satisfaction and professionalism. Educate customers about service verticals, upsell opportunities, and follow up for all services. Experience in Administration, inside sales, and Customer Service ...
Claims Adjuster - Liability
Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. To analyze mid- and higher-level general liability claims to determine ben...
Claims Adjuster Trainee
Claims Adjuster TraineeJoin Forbes' 2024 Best Employer for Diversity!. In a fast-paced environment, you'll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. We'll also teach you the insurance stuff - providing in-depth training on pro...
Customer Service Representative
As a Family Dollar Customer Service Representative you will be responsible for providing exceptional service to our customers. Key priorities include greeting customers, assisting them with selection of merchandise, completing transactions, and answering questions regarding the store and merchandise...
Customer Service Representative
The Customer Service Representative provides assistance to passengers and crew throughout the different stages of travel through our Jet Aviation FBOs. Provides new and existing customers with the best possible service in relation to billing inquiries, service requests, suggestions, and complaints i...