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Job DescriptionPrimary Purpose:Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. 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.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 necessaryEvaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approvalEvaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best optionMake 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 settlementDetermine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusionIdentify customer needs and work to meet those needs using appropriate customer service skillsDevelop an understanding of the functions of other departments, such as Policy Ops and MarketingTraineeShadow and learn the above stated essential duties and responsibilitiesLearn to handle most aspects of auto claimsDevelop a basic understanding of the content of policies written by the companyDevelop a basic understanding of the insurance industry and the organizational relationships of the companyLearn how to determine subrogation or fraud potential and how to handleDevelop a basic understanding of systems and technology used within the companyMinimum 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 experienceSuccessfully completes Claim Representative trainee program, or equivalent external training programProficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)Obtain/Maintain appropriate licensing or educational requirements Demonstrate proficiency in file audits to agreed standard of efficient claims qualityHigh degree of initiative, mature judgment, and discretionAbility to resolve conflicts and empathize with customers is criticalStrong negotiation skillsDemonstrate professional oral and written communication skillsOrganization and time management skills are critical for this positionDemonstrate an understanding of insurance law as it relates to claims TraineeLearn to recognize and identify all body parts of a vehicle and/or understanding other potential property damageDevelop understanding of claim policies & procedures; refers questions to supervisorDevelop ability to handle repair/replace decisionsDevelop labor judgment skills and learn to complete simple estimates accurately
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