Auto First Party Medical Claim Representative - Buffalo, NY

Military Spouse Corporate Career Network•Buffalo, NY

About The Position

As a Claim Representative, Auto First Party Medical (FPM), 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, and attorneys to resolve claims efficiently while providing professional, empathetic service. The position handles personal insurance claims with limited supervision and higher authority, and begins handling business insurance claims under direct supervision. Relevant insurance license(s) must be acquired and maintained within three months of starting the job to meet state and Travelers’ requirements.

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 applicable insurance license(s) within three months of starting the job.
Ability to communicate clearly and professionally verbally and in writing.
Sound judgment and effective decision-making ability.
Customer service skills and commitment to a positive customer experience throughout the claim process.
Attention to detail and organizational skills, including managing multiple tasks and priorities in a fast-paced environment.
Ability to facilitate productive discussions and reach equitable outcomes through conflict resolution.
Ability to manage stress, handle difficult situations, maintain composure and professionalism 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 it 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 and 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 relevant facts to determine coverage, causation and damages, medical necessity, treatment plans, and exposures.
Proactively manage medical treatment based on injury nature and extent, mechanism of injury, treatment received or anticipated, and wage loss, using case management and medical resources as needed.
Ensure proper payment of claims.
Communicate promptly and professionally with eligible parties, medical providers, attorneys, and internal stakeholders.
Determine settlement amounts, negotiate, and communicate claim settlements to eligible parties as appropriate.
Maintain accurate records of claim activity in claim management systems.
Learn continuously and adopt emerging technologies, particularly AI and digital transformation; adapt to technology implementations, system upgrades, and digital tool rollouts while maintaining productivity and service quality.
Acquire and maintain relevant insurance license(s) within three months of starting the job to comply with state and Travelers’ requirements.
Perform other duties as assigned.