Claims Representative Job Description

Claims Representative Job Description

4.5
176 votes for Claims Representative
Claims representative provides direction to implement at local level the claims strategy, claims policies and guidelines (settlement authorities, best practices etc.) governance.

Claims Representative Duties & Responsibilities

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

Sample responsibilities for this position include:

Recovery efforts through the preparation, filing and responses to inter-company arbitrations
This position will investigate Home losses for the appropriate coverage, investigate the facts via recorded statements, review estimates and appraisals of dwelling damage and settle these losses
Assist with the procurement of documentation for investor claim submission
Monitor the status of the Mortgage Insurance Claims
Refer loans once all investor claim proceeds are received and applied at loan level in the servicing system (MSP)
Partner with foreclosure attorneys to expedite resolution of title liens
Work closely with outsource vendors to submit claims to Investors and the Mortgage Insurance Companies
Reconcile account balances as they pertain to deductions and credit/debit memos
Constantly analyze customer behaviors to quickly identify problems or negative trends
This position may be responsible for sensitive Inter-company accounts such as Promo or Salesman Samples

Claims Representative Qualifications

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

Education for Claims Representative

Typically a job would require a certain level of education.

Employers hiring for the claims representative job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Communication, Computer, Associates, Agribusiness, Medical, Accounting, Administration, Foreign Languages

Skills for Claims Representative

Desired skills for claims representative include:

Offsets and deductions
Disability duration
Regulations
Medical management practices and Social Security and Medicare application procedure as applicable to line of business
Estimatics software
Systems and technology used within the company
Claims policies and procedures in resolving claims
Providing technical direction to claims representatives
Insurance policies and coverage
Material damage

Desired experience for claims representative includes:

Communication with the insured (inbound & outbound calls)
Investigation of documentation
Makes recommendations as to disposition of matter, settlement or defense
Maintains contact with attorneys, vendors, claimants and defendants to insure
To investigate, evaluate, manage and resolve short and long term disability claims within prescribed best practices and dollar authority granted by the Director
Responsible for benefit calculation period and appropriate forms to be filed

Claims Representative Examples

1

Claims Representative Job Description

Job Description Example
Our company is growing rapidly and is looking for a claims representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for claims representative
  • Handles claims within designated authority, ensuring compliance with appropriate statutory laws
  • Evaluates and negotiates claims, recognizes subrogable situations and initiates action
  • Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence
  • Evaluate, negotiate and resolve claims within delegated authority
  • Assess claims to determine required documentation and supporting information
  • Gather, through written or phone interactions, necessary documents including police reports, property repair estimates, and witness statements, as appropriate to the type of claim
  • Set up and control claim file according to prescribed policy/procedures and (respective) state and internal compliance requirements
  • Ensure satisfactory client experience by providing timely responsiveness and claim settlement within associate authority limits
  • Ensure claims and all associated facts/information are accurately and thoroughly documented in the claims administrative tracking system, including policy benefits/coverages and settlement information
  • Finalize claims and close files, per departmental procedures
Qualifications for claims representative
  • Review, evaluate and analyze information relating to claims, lawsuits and events by reviewing medical records, conducting interviews with hospital staff, and collecting evidence related to claims
  • Facilitate effective communication with hospital administration, professional and ancillary staff and outside legal counsel in order to assist in the defense of cases, which includes the preparation of cases for trials
  • Administer the professional and general liability insurance program, review correspondence, meeting with, guiding, and directing outside defense counsel to ensure compliance with the hospitals claims management program
  • Engage in settlement negotiations with plaintiffs’ attorneys within assigned authority levels, direct further action regarding defense strategy, settlements or appeals
  • Reviews workers compensation claims to determine if potential for Second Injury Fund recoveries exist
  • Pursues medical information necessary to qualify claim for acceptance by the Second Injury Fund
2

Claims Representative Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of claims representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for claims representative
  • Determines from knowledge and medical information secured whether to submit claim warrants to Second Injury Fund for acceptance
  • Reviews workers' claims and conducts investigations to determine if potential for subrogation exists
  • Gathers information necessary to support viable subrogation claim
  • Notifies appropriate parties of subrogation lien
  • Secures recovery from responsible parties
  • Prepares various type status reports for clients
  • Enters recoveries into the claims management system
  • Obtains settlement authority from state funds and negotiates compromise settlements with state funds
  • The Claims Adjuster performs a variety of tasks under the direction of the Claims Manager to investigate, evaluate, negotiate and settle claims according to the company standards, the Nevada Innkeepers Statute and applicable insurance coverage
  • Communicates and negotiates with a variety of individuals regarding investigation and settlement of claims
Qualifications for claims representative
  • Requires a minimum of one year of customer service related experience
  • Must possess excellent computer skills with a working knowledge of Microsoft Office with an emphasis in Word, Excel and Outlook
  • Must also possess knowledge of insurance concepts, practices & procedures
  • Candidates must be a minimum of 18 years or older
  • Must be bondable (criminal background check )
  • Ability to collaborate and work in a team environment work independently and make sound decisions
3

Claims Representative Job Description

Job Description Example
Our innovative and growing company is hiring for a claims 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 claims representative
  • Review assigned claim files to determine if recovery is feasible, investigate and evaluate liability issues, coordinates investigations by expert witnesses, pro-actively follow up with relevant parties, handle arbitrations, and refer cases to approved attorneys
  • Review assigned files for adequacy of investigation and recognition of recovery potential by claims personnel
  • Maintain a diary of facts and activity regarding assigned files, ensuring compliance with Statute of Limitation requirements
  • Research, understand and apply state laws that relate to each file
  • Approve and issue, within established guidelines and authority, indemnity and legal payments through the appropriate Claims Processing Systems
  • Train claims personnel in recovery recognition and procedures
  • Responsible for providing accurate and timely information to all external and internal stakeholders to address claim recovery status to support and inform decision making
  • Accountable for contributing to overall annual recovery goals
  • Update and continuously track vendor diaries to ensure recovery of monies due are timely and accurately reflected
  • Continuously follow up with vendors to deliver larger and faster recoveries in accordance to service level agreements
Qualifications for claims representative
  • Has the physical dexterity to walk, reach, climb, and crawl to inspect damage, sometimes in unfavorable working conditions or inclement weather
  • Must be able to lift, carry, and climb ladders weighing up to 50 pounds (only applicable if assigned to work property claims)
  • Work may involve overtime or extend beyond normal business hours due to business need or in the case of emergency situations
  • Insurance designation ( AIC ) a plus
  • A minimum of High School education required, Higher education in a related field a plus
  • Knowledge the Automotive transport industry preferred and 2 years with Auto claim adjustments
4

Claims Representative Job Description

Job Description Example
Our company is looking to fill the role of claims representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims representative
  • Must meet departmental production and quality standards related to product or level
  • May assist in training less experienced associates or quality check other associates’ work
  • Conduct depositions on behalf of the company/insured as permitted
  • Prepare and file motions, dismissals and declarations of readiness to proceed with the Board as permitted
  • Provide timely hearing reports/deposition summaries to the adjuster
  • Complete special tasks as assigned
  • Take continuing education courses to maintain licenses
  • Collect detailed information about the claim and enter into the AS400 system
  • Use computerized system or other tools provided for tracking, information gathering and issues or concerns raised by the customer
  • Determine claim eligibility by studying the extended service plan coverage and the terms and conditions
Qualifications for claims representative
  • Good attention to detail and ability to create and maintain a schedule
  • Ability to access enter, modify, and retrieve data on PC
  • Highly proficient in computer applications Microsoft Excel, Microsoft word and Outlook
  • Flexible to learn and navigate new software
  • Ability to read, write, and speak English language, composes correspondence, and develops a variety of business reports
  • Three to five years of job-related experiences
5

Claims Representative Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of claims 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 claims representative
  • Proactively investigate and gather information to support subrogation activities
  • Proactively negotiate salvage and subrogation settlements
  • Maintain reports and all documentation related to recovery activities
  • Perform claim handling and resolution as needed and required
  • Successfully complete all required company and industry/business related training and education
  • Proactively communicate activity and results as required by the job, department, and the business unit
  • Our client is seeking an experienced Auto, General & Liability (AGL) Claims representative for the Jersey City, NJ office
  • Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines
  • Under limited supervision, receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business
  • Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, to secure necessary claim information
Qualifications for claims representative
  • Knowledge of Recovery processes
  • Ability to handle files of relatively higher scope and complexity
  • Ability to lead/train claims and recovery staff
  • Basic organizational, interpersonal, negotiating and verbal communication skills
  • Four-year college degree or
  • Automotive related Associate of Applied Science degree from an accredited technical college or the experience described below

Related Job Descriptions

Resume Builder

Create a Resume in Minutes with Professional Resume Templates