Claims Representative

Claims Representative

Pennsylvania Lumbermens Mutual Insurance Company

Position: Claims Representative Department: Claims

Reports To: Claims Manager

Position Summary: Manage and direct the resolution of a caseload consisting of low complexity, high volume commercial property and casualty claims. This position interprets policies to confirm coverage, selects and assigns external experts and independent adjusters, determines the amount of loss and negotiates settlements within a specific range of assigned claim reserve and payment authority.

Essential Functions and Responsibilities:

• Promptly contact insureds, claimants and brokers to acknowledge receipt and assignment of new claims
• Determine coverage and liability in accordance with policy provisions, state regulations, and company guidelines
• Establish claim reserves within assigned monetary authority.
• Investigate claims by gathering statements, reviewing policy coverage, obtaining estimate, police reports, and other supporting documentation
• Assign independent adjusters and other experts to investigate losses and follow through to completion of investigation.
• Manage third party property damage claims by assessing liability, negotiating settlements, and processing payments
• Manage first party comprehensive and collision claims by verifying damages, securing repair or total loss valuations, and processing payments
• Evaluate all pertinent data on a claim to establish fair settlement range.
• Negotiate settlements and/or ACV of property.
• Facilitate salvage process by setting up salvage assignments, coordinating with vendors, lienholders, and owners for title procurement.
• Provide customer service through explanation of coverage decisions, next steps, and claim outcomes
• Issue Risk Alerts for specific underwriting hazards.
• Alert claim management to high exposure claims with potential to exceed reserve authority.
• Recognize indicators of fraud.
• Settle claims within assigned payment authority on a timely basis.
• Investigate subrogation potential and follow through to completion.

Knowledge and Skills:

• 4-Year college degree preferred.
• Working knowledge of coverage and claim investigation techniques.
• Basic MS Office skills.
• Strong oral and written communication skills. Bi-lingual in Spanish a plus.
• Attainment of adjuster licenses in required states (or willingness to attain upon hire).
• Strong organizational skills
• Ability to professionally interact with wide variety of different personalities.
• Ability to handle difficult situations calmly and rationally.

Physical Requirements:

• Ability to communicate effectively.
• Ability to sit for extended periods of time.
• Occasional travel as needed.