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Senior BI Telephone Claims Representative
Claims

US-FL-Miami

Posted: 11/1/2017
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Job Snapshot
CATEGORY: Claims LOCATION: US-FL-Miami
POSTING ID: 2820/1900/15854 EMPLOYEE TYPE: Full-Time
EXPERIENCE: Not Specified
Job Description

Primary Purpose:

Examine claims data, investigate the facts, determine liability and adjust claims of a serious and complex nature within the limit of authority.  Casualty and material damage claims with substantial damage and/or exposure may be involved.  Claims involved normally require detailed analysis and research to resolve coverage and/or damage issues.  Serve as mentor for others and assists with projects, and expected to work independently with minimal supervision as the manager relies upon this role in his/her absence.

 

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

  • Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement
  • Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; may inspect damaged property, and review loss reserves and adjust or opens hidden exposures as necessary
  • Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submits to manager for approval
  • Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
  • Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
  • Determine subrogation or fraud potential and refer to Unit when potential exists or handles to conclusion
  • If handling PIP may participate in investigations of medical providers and attend EUOs
  • May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files
  • May assist in training and development of Claim Representatives or serve as a mentor for claims representatives 
  • May assist with file reviews  and audits
  • Is proficient and able to train others in using all systems and technology used within the company
  • May be required to make personal appearances on behalf of the company when requested
  • May also assist manager with preparing reports and completing projects
  • Identify customer needs and work to meet those needs using appropriate customer service skills

 

Required Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
  • Successfully completes Claim Representative trainee program
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Obtain/Maintain appropriate licensing or educational requirements 
  • Demonstrate the capability of consistently handling aggregate file exposures of at least $15,000
  • Demonstrate proficiency in file audits to agreed standard of efficient claims quality
  • Has thorough knowledge of claims policies and procedures in resolving claims and/or providing technical direction to claims representatives
  • Often a source of directions for others on claim policies and procedures
  • Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine action plan, and rarely requires assistance on complex claims
  • Demonstrate thorough understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, and other potential exposures
  • If handling material damage, can accurately handle any type of material damages claim within limit of authority
  • When handling injury claims, can review, evaluate and negotiate any type of injury claim, and demonstrate ability to handle more serious injuries
  • When handling litigation, demonstrates ability to handle more complex litigation in accordance with company guidelines, recognize legal issues, and utilize ADR when appropriate
  • Demonstrate an understanding of insurance law as it relates to claims
  • Demonstrate the ability to find answers to more complex issues with insurance law
  • Demonstrate a working understanding of the insurance industry and organizational relationships of the company
  • High degree of initiative, mature judgment, and discretion
  • Ability to resolve conflicts and empathize with customers is critical
  • Strong negotiation skills
  • Demonstrate professional oral and written communication skills
  • Organization, customer service, and time management skills are critical for this position
  • Demonstrate an understanding of insurance law as it relates to claims
  • Demonstrate the ability to find answers to more complex issues with insurance law and may be a source of direction / assistance for other representatives
  • Demonstrates effective leadership and mentoring skills

 

Desired Skills:

  • Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
  • Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing
Job Requirements

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About National General Holdings:

National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

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