Claim Representative Job Description

Claim Representative Job Description

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Claim representative provides claim specific guidance to staff as applicable ensure proper investigation and timely equitable disposition of claims.

Claim Representative Duties & Responsibilities

To write an effective claim representative job description, begin by listing detailed duties, responsibilities and expectations. We have included claim representative job description templates that you can modify and use.

Sample responsibilities for this position include:

Adjust claims by evaluating and negotiating claims settlement
Write property estimates based off photos audit contractors and independent appraiser estimates for water losses over $2500 and $5000 for all other types of losses
Manage files through gathering of information via written or phone interactions and include proper documentation in the claim system
Identify and research process/procedure gaps and develop action plans to close the gaps
Catastrophe claims handling, consisting of an average of 100 claims per month during periods of Catastrophe events, providing support in a timely fashion to all regions
Conducts re-inspections of homes following inspection by other resources or associates
Establish the physical damage claims value of assigned losses
Participates in industry education or Home Office training as determined by Management
Investigates and adjusts claims, directs independent adjusters, experts, and other vendors in the claim handling processes
Advises underwriting of any information gathered which may affect risk assessment

Claim Representative Qualifications

Qualifications for a job description may include education, certification, and experience.

Education for Claim Representative

Typically a job would require a certain level of education.

Employers hiring for the claim representative job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Business, Education, Associates, Computer Technology, Acquisition, Construction, Medical, Computer, Communication, General Education

Skills for Claim Representative

Desired skills for claim representative include:

Estimating system Xactimate
Microsoft Office products and telephone protocol
Applicable bank
Federal Regulations
Relevant terminology to ensure accurate management of the claim
LOB specific competencies to ensure effective management of claims
Customer service drivers and the ability to resolve customer issues
Needs and concerns independently
Mastercard/Visa regulations and internal procedures
Products

Desired experience for claim representative includes:

Understanding of relevant laws and regulations governing property and casualty claims in the U.S. , Canada and Puerto Rico
Strong commitment to the principles of customer focus
Effective interpersonal skills and ability to communicate clearly in verbal and written communications
Strong negotiation skills and ability to deal effectively with plaintiff attorneys
Understanding of insurance coverage
Ensuring that all claims files and company information are kept confidential

Claim Representative Examples

1

Claim Representative Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of claim representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claim representative
  • Obtaining and analyzing leases, contracts, by-laws and other relevant documents which may have an impact on the adjustment of losses
  • Determining appropriate settlement amount based on independent judgment, computer assisted estimates, estimation of actual cash value and replacement value, appraisals, application of applicable limits and deductibles
  • Controlling damages through proper usage of cost containment tools
  • Ensure that management has accurate claim information by properly investigating loss claims by calling or writing insureds, claimants, agents, witnesses
  • Adjusts or denies claims, considering deductible amounts, depreciation, policy limits, Negotiates and explains decisions to insured’s, claimants, agents, as necessary
  • Prepare running notes/documentation, written reports, salvage disposal documentation in accordance with established procedures
  • Identify candidates for subrogation and initiate subrogation with first notice to adverse party
  • Plan, recommend, reserve, and execute file strategies on assigned claims in a manner consistent with corporate claim policies and procedures, and statutory, regulatory and ethics requirements
  • Recognize claim exposure
  • Handle high volume of claims which includes initial file intake, project and execute accurate and timely payments, investigate mitigation opportunities on the file including subrogation, manage file to timely resolution, and complete all data integrity components
Qualifications for claim representative
  • Comprehensive understanding of relevant laws and regulations, related medical and legal terminology
  • Requires strong claim technical skills
  • Excellent organizational skills with ability to work independently
  • Demonstrated ownership attitude and customer centric response to all assigned tasks
  • Requires a degree of initiative, independent judgment, and discretion
  • Minimum of 2 years of Homeowners/Property Claims Experience preferred
2

Claim Representative Job Description

Job Description Example
Our company is hiring for a claim representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claim representative
  • Plan, recommend & reserve assigned claims in a manner consistent with corporate claim policies and procedures, and statutory, regulatory and ethics requirements
  • Investigate mitigation opportunities on the file including recovery opportunities
  • Manage file to timely resolution
  • Accurately complete data screens
  • Applications will be accepted for this position through 3/20/2017
  • Investigate Claim Facts –Investigate and manage claim files w
  • Works with Claims, Marketing, Underwriting and Loss Control on account issues
  • Performs loss run reviews to ensure appropriate claims handling in accordance with Great American practices and state requirements
  • Negotiates and communicates special claim handling instructions with third party administrators
  • Serves as point of contact for service concerns and general questions
Qualifications for claim representative
  • 2-3 years of auto claims handling experience
  • Experience in the insurance industry or a call-center environment
  • Working knowledge of basic computer hardware and software, Microsoft Office Suite and database systems
  • Principles and processes for providing customer service including meeting quality standards for services and evaluation of customer satisfaction
  • Working knowledge of industry best practices and policies
  • Reside in the state of Idaho
3

Claim Representative Job Description

Job Description Example
Our innovative and growing company is looking for a claim representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claim representative
  • Collaborates and drafts Reservation of Rights, Excess and coverage letters for/with business partners
  • Evaluates and makes recommendations to executive management on internal and external issues of strategic importance to a product(s) and / or line of business
  • Must be open to travel, including overnight travel as needed
  • Determines available avenues of recovery and their cost-effectiveness
  • Conveys moderately complex information (coverage, decisions, outcomes, ) to all appropriate parties, maintaining a professional demeanor in all situations
  • Conveys simple to moderately complex information (coverage, decision, outcomes, ) to all appropriate parties, maintaining a professional demeanor in all situations
  • Investigates and maintains truck and trailer physical damage claims
  • Investigates and evaluates recovery potential
  • Conveys simple to moderately complex information (coverage, decisions, outcomes, ) to all appropriate parties, maintaining a professional demeanor in all situations
  • Make claim payments based on the claimant's contract and other information provided at initial time of claim or ongoing payments through the claims life cycle determining need for additional information to properly determine risk
Qualifications for claim representative
  • Excellent communication skills are critical to success in this position, strong analytical and problem solving skills, with the ability to negotiate and cope with stressful situations
  • Must have valid driver’s license and the ability to travel extensively, (approx
  • Moderate knowledge and understanding of policies and endorsements related to auto coverage
  • Moderate knowledge and understanding of each phase of the auto claim handling process
  • Demonstrated the ability to answer questions on repair process, estimate of damages and other basic physical damage related questions
  • Executing financial transactions and financial forecasting
4

Claim Representative Job Description

Job Description Example
Our company is hiring for a claim representative. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for claim representative
  • Investigates and maintains commercial general liability, property and auto claims
  • May affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority
  • Must obtain state adjusting licenses where required
  • Completes general claims processing to include verification of coverage, creating and mailing requested initial and status claim forms and other correspondence including confidential documents, OFAC search, draft/check entry for loss or expense payments, recoveries, identify and correct coding, claim set up, or payment errors as needed, ordering of police reports, medical records, wage loss information, sending medical records to providers, and the completion of ISO and indexing reports
  • Responds to incoming telephone inquiries from customers by providing accurate answers, investigating answers or forwarding the call to a person who can provide accurate answers
  • Assists with telephone contacts to policyholders, medical providers and others, as requested, to provide information or inquire as to claims status
  • Exercises sound judgment, initiative and technical vocabulary in preparing typed letters, forms and correspondence
  • Acts as lead support representative responsible for special projects as assigned, training and guidance to other CSRs
  • Processes new claim intake, setting up losses, logging them and assigning them to claim representatives
  • Assists in preparing files for independent medical examinations (IME)
Qualifications for claim representative
  • Bachelor’s degree and a minimum of 5 years of commercial general liability claims handling experience
  • Demonstrated ability to use the most effective methods of building rapport, demonstrating capability, gaining commitment and conveying ideas and information in order to develop and maintain client relationships
  • We will rely on the person who is hired to frequently interact directly with agents and brokers so strong customer service skills are essential to this position
  • Must be open to 20% travel, including overnight travel
  • Knowledge of policy interpretation, coverage and liability investigation and injury evaluation
  • Must have strong hands on experience with MS Office including Word, Excel and Outlook, the ability to learn proprietary software
5

Claim Representative Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of claim representative. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claim representative
  • Reviews and updates knowledge of medical terminology and policy/endorsement wording continuously
  • Set reserves within prescribed authority and submit written recommendations for reserves outside authority
  • Process incoming phone calls and initiate outbound calls with insurance agencies, companies, group personnel, customers and vendors as they relate to our risk management and insurance programs
  • Facilitate the coordination of roadside assistance and glass claims with customers and national vendors based on customer need
  • Validate, extend and monitor rentals that are part of active claims, updating information in multiple systems
  • Negotiate with glass and tow vendors to ensure fair and accurate pricing
  • Communicate with management and customers on losses that exceed approval limits
  • Administer third party liability claim reporting by submitting information to applicable brokers and carriers
  • Initiate first party claims, determine repair facility and assign appropriate responsibilities to department teams
  • Distribute estimate mailbox inquiries to proper repair team members
Qualifications for claim representative
  • Ability to work independently and maintain case load in a remote working environment
  • Minimum of 3-5 years of related claims handling experience
  • Inside position to be located in our Gainesville, GA office
  • Part of a formal training program
  • This is an entry level, inside position to be located in our Gainesville, GA office
  • Must have a minimum of 3 years of commercial auto claims experience

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