Manages a pending caseload of
moderate severity and complexity property and/or liability homeowner claims in
a team environment. Ensures prompt,
effective, and courteous handling of all claims to policyholders and claimants. Special emphasis is placed on complying with
The following duty statements
are illustrative of essential functions of the job and do not include other
non-essential or marginal duties that may be required.
1. Claim Assignment - Verifies policy information for accuracy
to determine if coverage is applicable on new claims. Develops an investigative
action plan to include resolution of coverage issues as required.
2. Claim Contact - Ensures that timely contact is made with
insured and claimants as defined by established guidelines. Responds
professionally and courteously when handling a claim. Contacts or interviews
necessary parties to get additional information.
3. Investigation - Evaluates assigned claims on an ongoing
basis and makes recommendations for further task assignments and other
information as needed to facilitate final claim disposition. Interprets policy provisions to approve or
deny payments. Determines when cases need to be elevated to a higher level.
Presents information in a thorough manner and participates in their discussion
4. Reserving - Ensures claims are adequately and timely
reserved by adjusting reserves or providing reserve recommendations to ensure
that reserve activities are consistent with established guidelines.
5. Processing - Reviews new claims, claim payments, reserves on
computer system and corrects information as needed by inputting data in a
concise, accurate and complete manner.
Pays and processes claims within designated authority level. Resolves moderate severity level claims
using high service oriented file handling techniques as defined by established
6. Diary and File Review - Maintains a current diary on all
assigned claims. Conducts periodic spot
checks of claim files not being followed in a regular diary to ensure
compliance with internal and external procedures and guidelines.
4-year college degree plus 3 years of property and /or liability (homeowners) claims handling experience, or a comparable combination of education and experience.
Demonstrated technical expertise in claims management.
Computer literacy and ability to use applicable software.
Appropriate licensing in the states in which the position handles.
Insurance certificates, courses, and/or professional designations a plus.
Strong oral and written communication skills used to interact with all levels of internal and external customers. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Active and attentive listening skills.
Establishes and maintains effective relationships.
Ability to interact with others to identify issues/problems and to correct problems.
Knowledge of principles and processes for providing customer service to include customer needs assessment, meeting quality standards for service, and evaluation of customer satisfaction.
Ability to prioritize tasks and work with multiple priorities.
Effective and timely decision-making skills.
Strong investigative and negotiation skills.
Ability to quickly gain a thorough knowledge and understanding of the homeowner policies and endorsements is critical.
Attention to detail.