Claims Specialist I

Department: Member Services - Claims Reports to: Claims Supervisor Job Level/FLSA: Professional/Managerial #1/Exempt Salary Range: $46,100-$60,100 Summary Investigates, evaluates and settles moderate to complex 1st and/or 3rd party claims by performing the following Essential Duties with or without the assistance of outside vendors and with or without the assistance management direction. May involve multiple lines of coverage and/or litigated files. Essential Duties and Responsibilities Provide excellent customer service to Agents, Insureds and 3rd parties through prompt contact, courteous and professional behavior, and prompt response to verbal and written inquiries. Conduct thorough and impartial investigations and evaluations that result in prompt fair settlements. Keep Management, Agents, Insureds and Claimants apprised of claim status. Determine if there is a need for the assistance of outside vendors and manage their participation throughout the claims process. Maintain accurate, complete and claim files that comply with Best Practices and statutory requirements that are accurately and appropriately reserved. Other duties as assigned. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice All employees are expected to participate in catastrophic events. Skills Required Must be able to read, analyze and understand technical reports, related documents. Must be able to verbally communicate decisions and negotiate effectively with all Customers, internal and external. Will be required to possess the skills to author reports and letters that are persuasive and professional. As most of the contact with Customers is done verbally and via telephone, individual must be able to speak clearly, politely, use proper grammar and terms that are familiar to the general public. Basic typing skills are essential. Some knowledge of Microsoft Word and related products is helpful. Must be able to gather information, establish facts, and evaluate data to determine coverage, liability and damages. Must be able to apply applicable law, contractual terms and conditions and statutory requirements to the decision-making process. Basic math skills that will allow preparation and evaluation of damage estimates as well as percentages for depreciation and liability. This job requires that the employee’s skills are continuously updated to keep abreast of changing policy forms, laws and statutory regulations. Qualifications Bachelor’s Degree, or 3 to 5 years’ experience in the Insurance Industry and/or a related technical field. Supervisory Responsibilities This position has no supervisory responsibilities. Physical Demands and Work Environment Most of this job is done in an office environment but may require onsite inspection or travel to meet with Agents, policyholders, claimants and vendors on occasion. Reasonable accommodations may be made to enable those with physical disability to perform essential functions. The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee will be required to sit, talk, see and hear. The employee is frequently required to use hands to type, key numbers and handle paper documents. Reasonable accommodations may be made to enable those with physical disabilities to perform essential functions. #J-18808-Ljbffr