Auto First Party Medical Claim Representative - Buffalo, NY
About The Position
As a Claim Representative in Auto First Party Medical, you will handle first-party medical claims from the first notice of loss through resolution, settlement, and payment. This detail-oriented, customer-focused role involves working with eligible parties, medical providers, attorneys, and internal stakeholders to resolve claims efficiently while providing professional, empathetic service. The representative typically handles personal insurance claims with limited supervision and higher authority, and begins handling business insurance claims under direct supervision. Relevant insurance licenses must be acquired and maintained within three months of starting.
Requirements
- High school diploma or GED.
- One year of auto claim handling experience, comparable claim experience, or successful completion of the required Travelers Claim Representative training program.
- Acquire and maintain relevant insurance license(s) within three months of starting the job.
- Strong verbal and written communication skills.
- Sound judgment and effective decision-making ability.
- Strong customer service skills and commitment to a positive customer experience.
- Attention to detail and organizational skills, including the ability to manage multiple tasks and prioritize in a fast-paced environment.
- Conflict resolution skills and ability to facilitate productive discussions and reach equitable outcomes.
- Ability to manage stress, handle difficult situations, remain composed and professional under pressure, and take accountability for decisions.
- Basic understanding of insurance principles and terminology, state insurance regulations, and claim handling requirements.
- Ability to learn quickly from experience and apply learning to new situations with speed and flexibility.
Nice To Haves
- Bachelor’s degree.
- Two years of auto claim handling experience.
- Active adjuster license, where applicable.
- Proficiency in claims management software, with advanced skills in Microsoft Office and enterprise technology systems and platforms.
Responsibilities
- Review, investigate, and document Auto First Party Medical claims under limited supervision.
- Gather information from eligible parties, medical providers, and attorneys.
- Investigate and evaluate facts to determine coverage, causation and damages, medical necessity, treatment plans, and exposures.
- Proactively manage medical treatment based on injury, mechanism of injury, treatment received or anticipated, and wage loss; use case management and medical resources as needed and ensure proper payment.
- Communicate promptly and professionally with eligible parties, medical providers, attorneys, and internal stakeholders.
- Determine settlement amounts, negotiate settlements, and convey them to eligible parties as appropriate.
- Maintain accurate records of claim activity in claim management systems.
- Continue learning and adopt emerging technologies, particularly AI and digital transformation tools.
- Adapt to technology implementations, system upgrades, and digital tool rollouts while maintaining productivity and service quality.
- Acquire and maintain relevant insurance licenses to comply with state and Travelers requirements within three months of starting.
- Perform other duties as assigned.
Benefits
- Performance-based cash incentive awards
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
