Provides customer service, administers, and examines policy coverage for complex injury and fraud claim settlement determinations within authority level.
- Handles complex cases (e.g. material misrepresentation, fatality losses according to state specific guidelines, and impact losses with injury claims).
- Answers questions from insureds, claimants, and attorneys to resolve problems and concerns.
- Reviews policy coverage and documents/processes complex personal injury protection claims. Uses claims systems to locate prior losses and to maintain claim information.
- Documents all conversations and recorded statements with involved parties, including correspondence, bills and actions.
- Documents files and pays submitted bills according to procedures.
- Sends necessary correspondence and completes actions to satisfy department of insurance and/or state specific regulations.
- Addresses diaries, correspondence, emails, and voicemail timely.
- Submits required reports to underwriting regarding claims issues.
- Opens reserves appropriate to reflect exposure to the policy.
- Identifies bodily injury and un-insured motorist claims and reassigns to appropriate department.
- Handles arbitration responses and assists litigation in handling of demands.
- Refers files to special investigation unit and assists with direction to the investigation.
- Detail-oriented with strong organizational skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.
- Demonstrated ability to work effectively under pressure and within a collaborative team oriented environment using sound judgment in decision-making.
- Excellent communication skills both oral and written with strong analytical skills.
- Excellent customer service and negotiation skills
- Demonstrated proficiency with Microsoft Office products (Excel, PowerPoint, and Word) and insurance software applications.
- Demonstrated knowledge of different bodily injury and/or loss claims.
- Must be able to travel 10%
Experience / Education:
- Bachelor?s degree in related field or equivalent education preferred.
- Four years of personal injury protection claims handling experience with one year arbitration and/or litigation required.