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Senior Claims Representative
QBE Insurance
Plano, TX, United States
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Manage portfolio by investigating (as required by line of business), researching and ensuring consistent and optimal disposition of claims, assessing and estimating damage, reviewing and analyzing various types of contracts/policies, negotiating settlements and making recommendations on legal and coverage issues. Responsible for working on medium to high volume of moderate complexity cases for assigned line(s) of business, including reinsurance and catastrophe claims.
This role will be responsible for the review, analysis and adjustment of small to mid-sized ($10K to $ 100K) property loss claims. The claims will be handled within a delegated settlement authority limit and will ensure compliance with state and internal requirements. The position will process claims by completing a detailed review estimates for accuracy, investigation assessing coverage, gathering all necessary documentation, negotiating all aspects of the claim, preparing detailed estimates using the designated estimating software, and delivering potential settlements as warranted. Assist with catastrophe losses as needed.
Primary Responsibilities
• Contacts all parties involved to complete full investigation (as required by line of business) of the facts and damages relevant to the claim
• Produce large loss reports with analysis to ensure appropriate claim reserves
• Evaluates and negotiates the resolution of claims within authority levels while mitigating damages to achieve cost effective claims outcomes
• Review and evaluate claims for coverage and further claim handling procedures to conclude within required statutory time frame
• Interpret policy/contract language and evaluate coverage issues of multiple
policies/contracts/endorsements, including identifying potential coverage issues and referring claims to Claims Unit Leader as needed, and determining liability and evaluating damages of all exposures related to the claim
• Identify and refer claims to subject matter experts or manager in a timely manner to maximize claim outcomes; ensure files are documented with all appropriate claim information
• Provide effective and timely communication to all internal and external stakeholders regarding claim status and other inquiries such as fraud, subrogation recovery, reserve adequacy and underwriting risks; build close partnerships throughout the life of the claim
• Support claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
• Utilize judgment and industry skill set to apply case reserves independently; review reserves on assigned claim files and recommend additional case reserves or other necessary changes
• Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
Additional Responsibilities
• Reviews estimates for accuracy and compliance with Independent Adjuster Guidelines and Best Practices. Revises estimates accordingly.
• Creates estimates in designated software by gathering supporting documentation (photos, measurements, estimates) to negotiate settlements with insureds or contractors.
• Complies with timeliness, accuracy and service standards of the company.
• Complies with the legal, statutory and regulatory requirements.
• Identifies and documents subrogation opportunities; Identifies and addresses salvage of damage or destroyed items.
• Identifies and investigates questionable and possible fraudulent activity.
• Must be able to interact professionally with field personnel, internal and external customers and departmental staff.
• Identifies estimating trends and shares audit findings with external vendors to drive performance.
• Performs other duties as assigned.
Required Qualifications
Education:
Bachelor's Degree or equivalent combination of education and work experience
Experience:3 years relevant experience
Licenses/Certifications:Maintain adjusters license in states requiring licensing
Preferred Qualifications
Experience:
4 years claims handling experience; increasing levels of responsibility
Licenses/Certifications:Progress toward an insurance designation such as Associate in Claims (AIC), Associate in Management (AIM), Chartered Property Casualty Underwriter (CPCU) or Senior Claim Law Associate (SCLA)
Preferred Knowledge
• Working knowledge of claims administration best practices and procedures
• Working knowledge of insurance products and services
• Understanding of relevant laws and regulations across multiple jurisdictions
• Understanding of market trends and organizational strategies
• Working knowledge of Microsoft Office Suite, general computer software and database systems
Preferred Competencies/Skills
• Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them
• Mediate and resolve conflict using a logical approach
• Identify relevant information and understand it’s impact
• Maintain integrity of claims portfolio and evidence
• Use multiple resources to gather and analyze significant data
• Leverage technical knowledge to make cost-effective decisions
• Encourage open communication, cooperation and knowledge sharing
• High attention to detail
• Implement planning to organize, prioritize and measure individual work
QBE Cultural DNA
Everything we do at QBE is underpinned by our DNA (which interlinks seven cultural elements) – because we know it's not just what we do that matters, it's how we do it that makes the difference. We expect all employees to role model and inspire the right behaviors that link to our cultural elements:
• We are customer-centered
• We are technical experts
• We are diverse
• We are fast-paced
• We are courageous
• We are accountable
• We are a team
Number of Openings:
6