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Posted: Wednesday, September 6, 2017 2:29 PM

Job Description:/h3:
Primary Purpose:
Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. Claims involved are usually subject to standardized procedures which lead to a settlement with limited exercise of discretion. Claims involved occasionally require analysis and may require research to resolve coverage and/or damage issues. There is supervisory review of ongoing progress and results of work. There is more focused supervision on all complex files.
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 verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability
:Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary
:Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
: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; document 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 handle to conclusion
:May handle more complex files with appropriate supervision to develop skills
:Develop a working knowledge of systems and technology used within the company
:Identify customer needs and work 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 basic 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
:For claims involving material damage, comply with the company material damage guidelines
:Can handle most types of comprehensive losses (theft, fire, and vandalism), accurately identify total losses
:For claims involving injuries, have a general understanding of how to review, evaluate, and negotiate injury claims
:High degree of initiative, mature judgment, and discretion
:Ability to resolve conflicts and empathize with customers is critical
:Strong negotiation skills
:Demonstrate professional oral and written communication skills
:Organization and time management skills are critical for this position
:Demonstrate an understanding of insurance law as it relates to claims
:Demonstrated proficiency with basic computer skills with word processing, spreadsheets, e

Source: https://www.tiptopjob.com/jobs/71006250_job.asp?source=backpage


• Location: miami

• Post ID: 63956738 miami
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