Commercial MD Telephone Claims Representative Trainee, I, II, Sr. - Erie - 16505
Financial Services - Insurance
100 Sommerheim Dr
Check out similar listings!
Loading some great jobs for you...
Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority.
Essential Duties and Responsibilities:
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
* Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary * Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval * Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option * Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement * Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion * Identify customer needs and work to meet those needs using appropriate customer service skills * Develop an understanding of the functions of other departments, such as Policy Ops and Marketing
* Shadow and learn the above stated essential duties and responsibilities * Learn to handle most aspects of auto claims * Develop a basic understanding of the content of policies written by the company * Develop a basic understanding of the insurance industry and the organizational relationships of the company * Learn how to determine subrogation or fraud potential and how to handle * Develop a basic understanding of systems and technology used within the company
* Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability * May handle more complex files with appropriate supervision to develop skills * Develop a working knowledge of systems and technology used within the company
* Receive claim assignments and verifies/investigates coverage and documents all appropriate information * Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file * If handling PIP may participate in investigations of medical providers and attend EUOs * May work with attorneys in resolving lawsuits * Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level * Track and document the quality of service provided by defense counsel and manage litigation and recovery costs * May assist in training of Claims Representatives * Proficient in using all systems and technology used within the company * May be required to make personal appearances on behalf of the company when requested
* Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement * May inspect damaged property during an investigation * May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files * May assist in training and development of other team members or serve as a mentor for others * May assist with file reviews and audits * Proficient and able to train others in using all systems and technology used within the company * May be required to make personal appearances on behalf of the company when requested * May also assist manager with preparing reports and completing projects
Minimum Skills and Competencies:
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience * Successfully completes Claim Representative trainee program, or equivalent external training program * Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint) * Obtain/Maintain appropriate licensing or educational requirements * Demonstrate proficiency in file audits to agreed standard of efficient claims quality * High degree of initiative, mature judgment, and discretion * Ability to resolve conflicts and empathize with customers is critical * Strong negotiation skills * Demonstrate professional oral and written communication skills * Organization and time management skills are critical for this position * Demonstrate an understanding of insurance law as it relates to claims
* Learn to recognize and identify all body parts of a vehicle and/or understanding other potential property damage * Develop understanding of claim policies & procedures; refers questions to supervisor * Develop ability to handle repair/replace decisions * Develop labor judgment skills and learn to complete simple estimates accurately
* Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500 * Has a basic command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor * Demonstrate the ability to interpret and