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Investigate, evaluate, reserve, negotiate and settle assigned claims in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, and disposition.
PRIMARY DUTIES AND RESPONSIBILITIES:
Timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consult with Unit Manager on use of Claim Coverage Counsel.
Investigate each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Take necessary statements.
Identify resources for specific activities required to properly investigate claims such as Subro, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Request through Unit Manager and coordinate the results of their efforts and findings.
Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Keep effective diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure, and establish proper indemnity and expense reserves.
Utilize evaluation documentation tools in accordance with department guidelines.
Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives. Recognize and implement alternate means of resolution.
May manage litigated claims. Develop litigation plan with staff or panel counsel, track and control legal expenses. Assure cost-effective resolution.
Maintain claim files, have an effective diary system, and document claim file activities in accordance with established procedures.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Recognize cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit.
Appropriately deal with information that is considered personal and confidential.
Compliance with Claim Department's Best Practices.
Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquires from agents and brokers.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws
Provide quality customer service and ensure file quality.
Share accountability with business partners to achieve and sustain quality results.
EDUCATION/COURSE OF STUDY:
College degree or equivalent in business discipline preferred.
State license where applicable & continuing education
Completion of claim handling training program.
Strong negotiation and customer service skills.
Demonstrated knowledge and ability in claims handling.
Advanced level knowledge and skill in claims and litigation.
Basic working level knowledge and skill in various business line products.
Poised, polished communication skills.
Hardware and software skills and abilities including computers and other similar electronic devices.
Demonstrated good organizational skills with the ability to prioritize and work independently.
Demonstrated strong written, verbal and interpersonal communication skills including the ability to convey and receive information effectively.
Leadership In A Matrix Environment
Communicates Effectively And Influences Others
Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
Travelers is a leading provider of property casualty insurance for auto, home and business. The company has operations in the United States,...