We currently have an opportunity available within our Claims Service Center organization for a Claims Representative II, working in our Bakersfield location. The primary purpose of a Claim Representative is to investigate, evaluate, and resolve commercial and personal lines claims. Demonstrates superior claim service and produces appropriate claim settlements to our clients. It is incumbent upon this individual to understand regulations and the jurisdiction(s) involved in the claims being evaluated.
- Responsible for the investigation, evaluation, adjustment and resolution of assigned Casualty Claims
- Able to communicate effectively with policyholders and their representatives
- Ability to draft coverage letters and provide effective direction to assigned claim service vendors
- Must assure quality compliance with applicable insurance regulations and statutes
- Maintain a high level of file quality based on DOI regulations and CIG claim standards
- Accountable for handling claims within assigned monetary authority and may handle claims exceeding monetary authority under the supervision of management with the requisite authority
- Conducts formal recorded statements from insureds and claimants
- Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
- Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.
- Ensures adequacy of reserves.
- Accountable for security of financial processing of claims, as well as security information contained in claims files.
- Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or co-defendants. Arranges for expert inspections involving third party or potential fraud actions as needed.
- Two to five years of claims handling experience
- Technical training in insurance claims and/or AIC designation is preferred.
- Strong written and oral communications skills required.
- Comprehensive knowledge of legal liability, general insurance policy coverage and state regulations.
- Thorough knowledge of claims investigation techniques as well as the medical and legal aspects of a claim
- Demonstrates good interpersonal skills including verbal and written communications