Senior Claims Representative, Bodily Injury: Independent Agent Channel

The Casualty Claim Representative will be responsible for the handling of First and Third Party Bodily Injury claims in a Personal Lines/Commercial environment for the Plymouth Rock Operation.

 

RESPONSIBILITIES
• Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims.
• Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues.
• Conduct field investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented and unrepresented claimant cases.
• Manage and direct outside vendors (Field/Counsel/Surveillance, etc.) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only necessary work is completed.
• Investigate cases timely so that reserves are established and maintained at proper levels. Revise reserves timely based on developments in the course of the claim.
• Investigate the validity of bodily injury claims being presented by individual insureds/claimants or attorneys representing insureds/claimants. Be aware of certain “Red Flags” to identify potential fraudulent claims. Refer to SIU for investigation timely.
• Handle complex claims to include coverage issues, UM/UIM, TNC, Commercial, Umbrella etc. Also, must have prior litigation handling.
• Recognize and investigate subrogation potential.
• Negotiate both 1st and 3rd party claims directly with injured parties and/or their attorneys.
• Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution.
• Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials.
• Attend all internal and external training events as required.
• Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management.
• Utilize all claims systems, Excel, Word and social media search engines.
• Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtable discussions.
• Effectively manage workload while maintaining diary and focus on claims quality.
• Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
• Adhere to departmental internal control requirements. Comply with Plymouth Rock’s standards, best practices and ethical guidelines, adhere to Plymouth Rock’s culture.

 

QUALIFICATIONS
• A bachelor's degree (B.A.) from an accredited four year college or university.
• 5 - 10 years’ experience handling liability commercial, homeowners, UM/UIM, Excess/Umbrella.
• In-depth knowledge of litigation, arbitration and trial process, handle out of state claims, and/or Personal Injury Protection claims.
• Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.). Professional designation such as IIA, AEI, Senior Claim Law Associate (SCLA) or Chartered Property Casualty Underwriting (CPCU) or be actively working towards a designation, preferred.
• High level of self-motivation.
• Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation.
• Strong communication, organizational, customer service and time management skills.
• Excellent problem solving skills.
• Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.

PERKS & BENEFITS
• 4 weeks accrued paid time off + 9 paid national holidays per year
• Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
• Annual 401(k) Employer Contribution
• Free onsite gym at our Woodbridge Location
• Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
• Robust health and wellness program and fitness reimbursements
• Various Paid Family leave options including Paid Parental Leave
• Tuition Reimbursement

ABOUT THE COMPANY
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environ