About The Position

This job is responsible for investigating moderate/complex represented claims which typically will include claims in single or multi car accidents and represented moderate or major claims. The individual also may handle complex and highly complex specialized claims (e.g., business interruption, loss of income, Errors and Omissions (E&O) policies, etc.). The individual oversees liability and bodily injury investigations, takes recorded statements, resolves loss of use claims, makes payments to appropriate parties, and negotiates and settles or refers bodily injury issues that cannot be resolved. It is likely that this position will mainly handle represented claims for the following states: NJ, NY, PA. Candidates within the Eastern time zone are preferred, however, those on Central time zone will also be considered.

Requirements

  • Prior represented casualty claim handling experience is required
  • NY, NJ, PA claims experience preferred
  • 2-5 years of moderate/complex Bodily Injury claim handling experience is required
  • Proficient communication skills, especially over the phone, to establish rapport and assess claims accurately.
  • Ability to work independently and remotely, while managing time efficiently.
  • Familiarity with insurance policies, coverage, and liability determination.
  • Strong critical thinking and problem-solving skills to evaluate and negotiate injury claims successfully.
  • Knowledge of innovative tools and platforms for effective claims evaluation.

Responsibilities

  • Summarizes documents and enters into claim system notes
  • Manages, researches, and resolves complex and highly complex customer communications, concerns, conflicts or issues
  • Reviews medical reports in preparation for claims settlement evaluation
  • Researches, responds to, or participates in Department of Insurance complaints or investigations
  • Negotiates and settles claims in accordance with business unit best practices
  • Sets initial reserve, updates reserve, documents rationale and claim summary notes
  • Determines and explains minimum coverage limits in complex and highly complex claims involving single or multiple claimants, also determines claim value
  • Documents a claim file with notes, evaluations and decision making process

Benefits

  • Competitive pay with needed support for continuous development and career advancement.
  • Flexibility in scheduling and a time off policy that helps support your work/life balance.
  • Initial and ongoing training to get you proficient in your new role
  • Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life.
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