JOB DESCRIPTION

KEY OBJECTIVE:

This role is focused on the technical claim handling of auto liability and workers compensation claims. The individual will be accountable for the handling and disposition of claims including investigation, coverage determination, reserving, negotiation and settlement and overall claim strategy. The position may require travel. You will represent the company at meetings with management, business partners and in other claim related activities.

MAJOR DUTIES & RESPONSIBILITIES:

Duties include but are not limited to:

• 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.
• Supervise junior claims representative in the handling of claims under the assigned accounts
• Review applicable insurance policies to confirm coverage. Insure each file is timely reported to the applicable primary, excess or reinsurers.
• Maintain diary system to insure that each file is reviewed every 90 days.
• Attend monthly and/or quarterly claims committee meetings and be prepared to present cases for discussion in detail assuring the client can make decisions relating to strategy and reserving in an educated manner.
• Be aware of and Implement the company's approved best practices on each file to insure timely and effective claims management. In addition insured that each file has a completed case strategy summary with an appropriate disposition plan of action.
• Monitor defense counsel to insure compliance with the client's and/or ESIS's reporting requirements.
• Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader and the client.
• Timely review and process defense counsel and third party invoices to insure timely payment.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Settles claims promptly and equitably.
• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
• Informs claimants, insureds/customers or attorney of denial of claim when applicable.
• Assist the marketing team as new opportunities arise.

QUALIFICATIONS

Desired

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