Claims Representative Job Description
Claims Representative Duties & Responsibilities
To write an effective claims representative job description, begin by listing detailed duties, responsibilities and expectations. We have included claims representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Claims Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Claims Representative
Typically a job would require a certain level of education.
Employers hiring for the claims representative job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Communication, Computer, Associates, Agribusiness, Medical, Accounting, Administration, Foreign Languages
Skills for Claims Representative
Desired skills for claims representative include:
Desired experience for claims representative includes:
Claims Representative Examples
Claims Representative Job Description
- Handles claims within designated authority, ensuring compliance with appropriate statutory laws
- Evaluates and negotiates claims, recognizes subrogable situations and initiates action
- Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence
- Evaluate, negotiate and resolve claims within delegated authority
- Assess claims to determine required documentation and supporting information
- Gather, through written or phone interactions, necessary documents including police reports, property repair estimates, and witness statements, as appropriate to the type of claim
- Set up and control claim file according to prescribed policy/procedures and (respective) state and internal compliance requirements
- Ensure satisfactory client experience by providing timely responsiveness and claim settlement within associate authority limits
- Ensure claims and all associated facts/information are accurately and thoroughly documented in the claims administrative tracking system, including policy benefits/coverages and settlement information
- Finalize claims and close files, per departmental procedures
- Review, evaluate and analyze information relating to claims, lawsuits and events by reviewing medical records, conducting interviews with hospital staff, and collecting evidence related to claims
- Facilitate effective communication with hospital administration, professional and ancillary staff and outside legal counsel in order to assist in the defense of cases, which includes the preparation of cases for trials
- Administer the professional and general liability insurance program, review correspondence, meeting with, guiding, and directing outside defense counsel to ensure compliance with the hospitals claims management program
- Engage in settlement negotiations with plaintiffs’ attorneys within assigned authority levels, direct further action regarding defense strategy, settlements or appeals
- Reviews workers compensation claims to determine if potential for Second Injury Fund recoveries exist
- Pursues medical information necessary to qualify claim for acceptance by the Second Injury Fund
Claims Representative Job Description
- Determines from knowledge and medical information secured whether to submit claim warrants to Second Injury Fund for acceptance
- Reviews workers' claims and conducts investigations to determine if potential for subrogation exists
- Gathers information necessary to support viable subrogation claim
- Notifies appropriate parties of subrogation lien
- Secures recovery from responsible parties
- Prepares various type status reports for clients
- Enters recoveries into the claims management system
- Obtains settlement authority from state funds and negotiates compromise settlements with state funds
- The Claims Adjuster performs a variety of tasks under the direction of the Claims Manager to investigate, evaluate, negotiate and settle claims according to the company standards, the Nevada Innkeepers Statute and applicable insurance coverage
- Communicates and negotiates with a variety of individuals regarding investigation and settlement of claims
- Requires a minimum of one year of customer service related experience
- Must possess excellent computer skills with a working knowledge of Microsoft Office with an emphasis in Word, Excel and Outlook
- Must also possess knowledge of insurance concepts, practices & procedures
- Candidates must be a minimum of 18 years or older
- Must be bondable (criminal background check )
- Ability to collaborate and work in a team environment work independently and make sound decisions
Claims Representative Job Description
- Review assigned claim files to determine if recovery is feasible, investigate and evaluate liability issues, coordinates investigations by expert witnesses, pro-actively follow up with relevant parties, handle arbitrations, and refer cases to approved attorneys
- Review assigned files for adequacy of investigation and recognition of recovery potential by claims personnel
- Maintain a diary of facts and activity regarding assigned files, ensuring compliance with Statute of Limitation requirements
- Research, understand and apply state laws that relate to each file
- Approve and issue, within established guidelines and authority, indemnity and legal payments through the appropriate Claims Processing Systems
- Train claims personnel in recovery recognition and procedures
- Responsible for providing accurate and timely information to all external and internal stakeholders to address claim recovery status to support and inform decision making
- Accountable for contributing to overall annual recovery goals
- Update and continuously track vendor diaries to ensure recovery of monies due are timely and accurately reflected
- Continuously follow up with vendors to deliver larger and faster recoveries in accordance to service level agreements
- Has the physical dexterity to walk, reach, climb, and crawl to inspect damage, sometimes in unfavorable working conditions or inclement weather
- Must be able to lift, carry, and climb ladders weighing up to 50 pounds (only applicable if assigned to work property claims)
- Work may involve overtime or extend beyond normal business hours due to business need or in the case of emergency situations
- Insurance designation ( AIC ) a plus
- A minimum of High School education required, Higher education in a related field a plus
- Knowledge the Automotive transport industry preferred and 2 years with Auto claim adjustments
Claims Representative Job Description
- Must meet departmental production and quality standards related to product or level
- May assist in training less experienced associates or quality check other associates’ work
- Conduct depositions on behalf of the company/insured as permitted
- Prepare and file motions, dismissals and declarations of readiness to proceed with the Board as permitted
- Provide timely hearing reports/deposition summaries to the adjuster
- Complete special tasks as assigned
- Take continuing education courses to maintain licenses
- Collect detailed information about the claim and enter into the AS400 system
- Use computerized system or other tools provided for tracking, information gathering and issues or concerns raised by the customer
- Determine claim eligibility by studying the extended service plan coverage and the terms and conditions
- Good attention to detail and ability to create and maintain a schedule
- Ability to access enter, modify, and retrieve data on PC
- Highly proficient in computer applications Microsoft Excel, Microsoft word and Outlook
- Flexible to learn and navigate new software
- Ability to read, write, and speak English language, composes correspondence, and develops a variety of business reports
- Three to five years of job-related experiences
Claims Representative Job Description
- Proactively investigate and gather information to support subrogation activities
- Proactively negotiate salvage and subrogation settlements
- Maintain reports and all documentation related to recovery activities
- Perform claim handling and resolution as needed and required
- Successfully complete all required company and industry/business related training and education
- Proactively communicate activity and results as required by the job, department, and the business unit
- Our client is seeking an experienced Auto, General & Liability (AGL) Claims representative for the Jersey City, NJ office
- Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines
- Under limited supervision, receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business
- Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, to secure necessary claim information
- Knowledge of Recovery processes
- Ability to handle files of relatively higher scope and complexity
- Ability to lead/train claims and recovery staff
- Basic organizational, interpersonal, negotiating and verbal communication skills
- Four-year college degree or
- Automotive related Associate of Applied Science degree from an accredited technical college or the experience described below