Claims Representative - Consumer

PRIMARY PURPOSE: To analyze reports claims, determine benefits due and make timely payments and adjustments; to make timely payments and adjustments for specified program claims including high value and complex claims; to coordinate investigative efforts; to thoroughly review contested claims; to negotiate settlement of claims up to the designated authority level; and to provide superior customer services.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program.
• Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client.
• Adjudicates proper settlement up to designated authority level.
• Works directly with underwriter/client on high value and complex cases.
• Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines..

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Bachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience
Three (3) years of claims management experience or equivalent combination of experience and education required.

Skills & Knowledge

• In-depth knowledge of first party property and casualty claim adjudication as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Excellent analytical and interpretive skills
• Excellent organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.