Senior Claim Representative I

SUMMARY:

To provide prompt, cost effective and efficient examination, investigation and settlement or denial of insurance claims up to the highest and most severe exposure with minimal supervision, by exercising independent decision- making skills and judgment.

RESPONSIBILITIES/TASKS: 

• Adjust a caseload of assigned files, including more severe and/or complex claims, in accordance with Ameritrust Group’s policies and procedures.
• Maintain an active diary on 100% of caseload files, with a current plan of action.
• Adhere to assigned authority limits for reserving and payments (including settlements).
• Exercise independent decision-making skills with minimal to moderate supervision and direction on claims assigned, using knowledge of local codes, laws, standards and case-law.
• Verify coverage, investigate the loss by gathering all pertinent information, evaluate the claim, set reserves, negotiate settlements or deny payments where no coverage, liability or compensability exists.
• Record statements, obtain documentation such as police reports, medical reports, appraisals, estimates, photographs, etc. to process claims in accordance with Company Best Practices.
• Evaluate loss, assess reserve and settlement value where applicable and settle cases with claimants, insureds and attorneys autonomously. 
• Decide on denial of coverage, liability or compensability. 
• Identify and thoroughly investigate all possible recovery and subrogation opportunities revealed in the claims handled. 
• File all state and/or federal forms, filings and reports in accordance with statutory Guidelines.
• Return all telephone calls within one (1) business day, when possible.  All messages are to be returned by the end of the same business day in which the call was received.  Reports all service complaints to Claims Supervisor or Claims Manager immediately upon receipt.
• Maintain personal compliance with all continuing education requirements as mandated by statute or by office policy.
• Manually or electronically document files in a timely fashion with all appropriate information, in a legally accepted, factual manner.
• Understand coverage issues, including more severe and/or complex claims, with good knowledge of exclusions, endorsements on standard ISO forms.
• Provide training to other Claims personnel when required by Claim Management. 
• Recognize settlement or exposure value and be able to use tools to assist in settling cases, such as structured settlements, arbitration, mediation, etc.
• Must adhere to the company code of ethics.
• Professional and timely communication with all internal and external vendors.
• Performs related duties as assigned
• Attendance

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS

EDUCATION

• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. 
• Continuous learning, as defined by the Company’s learning philosophy, is required. 
• Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE

• Seven years of progressively more responsible experience in a claims environment that provides the necessary skills, knowledge and abilities. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.  A concentration in property and casualty would be preferred; or Two years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor-intensive customers.

QUALIFICATIONS

• Ability and proficiency in the use of computers and company standard software specific to position.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to act as a representative of the Company and establish effective working relationships.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to make independent decisions.
• Ability to solve highly complex problems. 
• Ability to train and mentor others.
• Ability to lead others.

WORKING CONDITIONS:

Work is mostly performed in an office setting with no unusual hazards.  Travel is required. Must be able to drive an automobile and have valid operator license. Specific vision abil