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Posted: Monday, September 25, 2017 10:11 PM

Job Description:/h3:
Primary Purpose:
Examines claims data, investigates the facts of loss, determines coverage and liability, and adjusts claims within limit of authority. Claims involved frequently require analysis and may require research to resolve coverage and/or damage issues. There is periodic review of ongoing activities and results of work. There is more focused supervision on complex files (The CRII will handle complex files on a regular basis).
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.
: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
:Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; and review loss reserves and adjust or open hidden exposures as necessary
:Evaluate and adjust claims within limit of authority
: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; documents 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 handles to conclusion
: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
:Perform other projects and assignments as directed
:Is 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
:Identify customer needs and works to meet those needs using appropriate customer service skills
Required 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.
:Bachelors 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 the capability of consistently handling aggregate file exposures of at least 2,500
:Demonstrate proficiency in file audits to agreed standard of efficient claims quality
:Has a solid command of the claims policies and procedures; exhibit basic interpretation of policies and procedures in resolving claims, but may still need some assistance from supervisor
:Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files
:Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures
:For claims involving injuries, has solid understanding of how to review, evaluate, and negotiate injury claims
:Demonstrate ability to handle litigation in accordance with company guidelines, and be able to recognize legal issues and w

Source: https://www.tiptopjob.com/jobs/71642126_job.asp?source=backpage


• Location: Buffalo

• Post ID: 30857282 buffalo
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