Senior Claims Representative, Casualty (Woodbridge)

The Senior Casualty Claim Representative will be responsible for the handling of First- and Third-Party Bodily Injury and Physical Damage claims in a Personal Lines /Commercial environment for the Plymouth Rock Operation. The candidate must have the skills listed below and be able to perform the following duties

RESPONSIBILITIES

• Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims.
• Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues.
• Willing to conduct investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented claimant cases.
• Manage and direct outside vendors (Field/Counsel/Surveillance, Etc..) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only necessary work is completed.
• Investigate cases timely so that reserves are established and maintained at proper levels. Revise reserves timely based on developments in the course of the claim.
• Investigate the validity of bodily injury claims being presented by individual insureds/claimants or attorneys representing insureds/claimants. Be aware of certain “Red Flags” to identify potential fraudulent claims. Refer to SIU for investigation timely.
• Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation. Handle more complex claims to include coverage issues, UM/UIM, etc.. Also, must have prior litigation handling.
• Recognize and investigate subrogation potential.
• Negotiate both 1st and 3rd party claims directly with injured parties or their attorneys.
• Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution.
• Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials.
• Attend all internal and external training events as required.
• Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management.
• Possess strong organizational skills, able to demonstrate time management, has the ability to prioritize multiple tasks/duties, and be proficient in the utilization of all claims systems, Excel, Word and social media search engines.
• Have strong communication skills both verbal and written. Provide strong customer service. Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtables.
• Capable of working independently without close supervision, high level of self motivation, effectively manage workload while maintaining diary and focus on claims quality.
• Ability to handle multiple responsibilities and be adept at conflict resolution while working in a team environment. Work well under pressure. Able to think strategically, solve problems, set priorities, make the necessary decisions to resolve complex/regular issues/claims.
• Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
• Adhere to departmental internal control requirements. Comply with Plymouth Rock’s standards, best practices and ethical guidelines, adhere to Plymouth Rock’s culture

QUALIFICATIONS

• A bachelor's degree (B.A.) from an accredited four year college or university.
• 3 - 5 years’ experience handling liability and/or Personal Injury Protection claims.
• 4+ years of experience handling bodily injury or casualty claims.
• Some litigation experience and knowledge of the New Jersey court system is preferred.
• Knowledge of PA, CT or NY claims handling would be beneficial.
• Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.) is preferred

The pay range for this position is $81,000 to $105,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.

PERKS & BENEFITS

• 4 weeks accrued paid time off + 9 paid national holidays per year
• Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
• Annual 401(k) Employer Contribution
• Free onsite gym at our Woodbridge Location
• Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
• Robust health and wellness program and fitness reimbursements
• Various Paid Family leave options including Paid Parental Leave
• Tuition Reimbursement