Material Damage Telephone Claims Representative Trainee, I, II, Sr.

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.

• Bachelor's 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 & 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, email and internet

Desired Skills:

• Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
• Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing