JOB OBJECTIVE:

Investigate, evaluate, negotiate and settle bodily injury claims and any related coverages within established best practices and applicable jurisdictional guidelines.

ESSENTIAL FUNCTIONS: 

• Handle injury claims including personal and commercial auto, uninsured and underinsured motorists, homeowners’ liability and commercial liability and limited litigation files.  Claims may involve serious or permanent injuries, including fatalities.  Claims may be assigned as first notice, requiring a complete investigation and handling of all aspects of the claim, or may be a reassignment of the injury claim only.     
• Review and analyze coverage, apply policy conditions, provisions, exclusions and endorsements and verify applicable limits, deductibles and co-insurance.
• Investigate and gather information, including taking statements as necessary, to determine the facts of loss, liability and subrogation potential.   
• Proactively manage and continuously evaluate the claim with specific emphasis on the nature and extent of injury, causality and relatedness of medical treatment received. Conduct a medical history investigation as necessary.
• Determine and continually evaluate appropriate reserves.  
• Establish a plan of action and utilize appropriate resources as necessary to move the file towards resolution. 
• Effectively investigate, evaluate, negotiate and settle a minimum average of 20 losses per month.  Negotiations will be primarily on the phone but may occasionally require personal contact.   
• Comply with claims organization policies, established best practices and jurisdictional guidelines.  
• Complete comprehensive reports and authorization requests as required.
• Maintain competency in the use of multiple claims systems and manage efficient and effective follow-up practices.  
• Obtain state licensing as required.
• Serve as a member of claims teams as assigned. 

OTHER FUNCTIONS: 

• Maintain an ongoing understanding of claims processes, procedures and systems, and keep current on fair claims practices laws, compliance issues, and business-related developments.
• Maintain open lines of communications with all stakeholders including resolution specialists that may be involved in the handling of other elements of the file.  
• Attend seminars and workshops as required.
• Occasional travel may be required.
• Perform other duties and special assignments as requested to support business needs.

KNOWLEDGE. SKILLS AND EXPERIENCE:

• This position requires a college degree or equivalent and a strong understanding of insurance and the claims organization. 
• Continuing education is strongly preferred and may be obtained through the Institutes (Associate in Claims (AIC) and/or Chartered Property Casualty Underwriter (CPCU) designations) or other accredited insurance education provider.     
• This position requires considerable experience as a claims resolution specialist or the equivalent experience in the industry or a related field. 
• The candidate must have excellent telephone and personal claims negotiations, communication and investigation skills. 
• The individual must understand tort law and must have thorough knowledge of medical terms and treatments. 
• The candidate must be able to obtain, analyze and evaluate medical history and documentation. 
• The candidate must possess detail-oriented organizational skills. 
• The candidate must demonstrate a proven ability to evaluate serious and complicated injury claims and to negotiate to a successful conclusion.  
• This position requires an excellent knowledge of all personal and commercial lines policies and coverage written by the company.