Third Party Sr. Claims Representative

Third Party Sr. Claims Representative

The Third Party Sr. Claims Representative is responsible for managing complex, high-exposure third-party claims from initial reporting through final resolution. This role independently investigates claims, evaluates coverage, liability, and damages, negotiates settlements, manages repairs and total losses, and ensures claims are resolved accurately, efficiently, and in accordance with applicable requirements. This position works closely with claimants, clients, attorneys, repair facilities, vendors, and internal departments and may also provide guidance, mentoring, and training to other members of the Third Party Claims team.

Essential Duties and Responsibilities

The essential duties and responsibilities include, but are not limited to, the following:

• Review and send First Notice of Loss (FNOL) notifications in accordance with established client requirements.
• Manage a high-volume caseload of complex and high-exposure third-party claims from initial reporting through closure.
• Complete claims-related administrative activities, including preparing correspondence, gathering and uploading documentation, coordinating towing services, and managing shared inbox responsibilities.
• Contact claimants, clients, witnesses, repair facilities, attorneys, and other involved parties to obtain information necessary for claim investigation and resolution.
• Review claims and applicable client parameters to verify coverage.
• Conduct thorough claim investigations, including interviewing involved parties and reviewing police reports, statements, photographs, estimates, and supporting documentation.
• Evaluate liability and determine appropriate claim-handling strategies based on investigative findings.
• Identify potential indicators of fraudulent activity and escalate suspicious claims for additional investigation when appropriate.
• Evaluate claims with a focus on accurate, timely, and cost-effective resolution.
• Assess damages involving vehicle repairs, property damage, total losses, rental expenses, towing, loss of use, diminished value, lost wages, and other applicable expenses.
• Determine whether damaged vehicles or property should be repaired or handled as a total loss based on claim circumstances.
• Monitor vehicle repairs and communicate with repair facilities to ensure work progresses accurately and within appropriate timeframes.
• Manage total loss claims, including reviewing vehicle history, market comparables, salvage information, and other documentation used to determine actual cash value.
• Coordinate rental vehicle needs, including verifying applicable parameters, explaining rental terms, initiating rentals, and authorizing extensions within established guidelines.
• Review supplemental repair requests and authorize additional repair costs within established authority and client guidelines.
• Evaluate liability and damages to determine appropriate settlement amounts and negotiate resolutions with claimants, attorneys, clients, and other involved parties.
• Establish and maintain appropriate financial reserves based on anticipated claim exposure.
• Process accurate and timely payments for vehicle repairs, total loss settlements, and other approved claim expenses.
• Maintain complete and accurate claim files, including detailed documentation of correspondence, investigative findings, decisions, payments, and claim activity.
• Maintain professional and timely communication with claimants, clients, attorneys, vendors, peers, and leadership throughout the claims process.
• Ensure claims are handled in accordance with applicable federal and state laws, fair claims practices, client requirements, and company procedures.
• Obtain and maintain required insurance adjuster licensing.
• Manage workload effectively while meeting established productivity, quality, service, and performance expectations.
• Ensure required claim activities and documentation are completed before finalizing and closing claims.
• Provide guidance, mentoring, and training to other Third Party Claims team members as assigned.
• Apply coaching and performance feedback to support continued professional development.
• Perform other duties and special projects as assigned.

Required Qualifications

• Associate degree or equivalent from a two-year college or technical school; one to four years of related experience and/or training; or an equivalent combination of education and experience.
• Previous experience handling insurance claims or related claims management responsibilities.
• Ability to independently investigate claims, evaluate liability and damages, and make sound claim-handling decisions.
• Ability to obtain and maintain insurance adjuster licensing as required in applicable states.
• Strong written and verbal communication skills.
• Ability to manage a high-volume caseload while maintaining accuracy and meeting established deadlines.

Preferred Qualifications

• Previous third-party claims handling experience.
• Experience in automotive, fleet management, claims management, or vehicle remarketing.
• Experience handling complex property damage, repair, total loss, rental, and liability claims.
• Experience negotiating settlements with claimants, attorneys, clients, or other involved parties.
• Knowledge of federal and state insurance regulations and fair claims practices.
• Experience mentoring or training less-experienced claims professionals.

Knowledge, Skills & Abilities

• Comprehensive understanding of insurance principles, coverage, and liability claims.
• Strong knowledge of liability assessment, including the ability to determine fault and evaluate comparative or contributory responsibility.
• Strong investigative skills with the ability to gather information, conduct interviews, review documentation, and identify inconsistencies.
• Ability to recognize potential indicators of fraud and appropriately escalate suspicious claims.
• Strong negotiation and conflict-resolution skills.
• Strong active listening and questioning skills.
• Ability to clearly explain claim processes, requirements, and decisions to claimants and clients.
• Ability to communicate professionally and empathetically when handling difficult or sensitive claim situations.
• Excellent written communication skills and the ability to maintain clear, detailed, and accurate claim documentation.
• Strong analytical, critical-thinking, and problem-solving abilities.
• Strong organizational and time-management skills with the ability to prioritize competing responsibilities.
• Strong attention to detail when reviewing claim documentation, damage assessments, payments, and settlement information.
• Ability to adapt to changing regulations, procedures, client requirements, and claim circumstances.
• Strong ethical judgment and ability to handle claims objectively.
• Proficiency with claims management systems, Microsoft Office, and general business technology.
• Ability to perform claim-related calculations involving lost wages, payments, depreciation, repair costs, replacement costs, and settlement amounts.

Physical Demands & Work Environment

• Work is performed primarily in a professional office or approved hybrid work environment.
• Requires prolonged sitting, typing, telephone use, and computer work.
• Must be able to communicate effectively in person, virtually, and by telephone.
• Occasionally lift, carry, push, pull, or move up to 10 pounds.
• Requires close visual attention when reviewing claims documentation, estimates, reports, correspondence, and computer screens.
• Regular use of wrists, hands, and fingers is required for computer and telephone-related tasks.

Work Schedule

The standard schedule for this position is Monday through Friday, 8:00 a.m. – 5:00 p.m. Following successful completion of the first 90 days, employees may be eligible for a hybrid work schedule based on departmental needs, business requirements, training completion, and performance expectations.