Claim Representative Auto

Responsibilities The Claims Service Center (CSC) is responsible for the administration of claims, with claims units handling specific insurance lines i.e., workers'' compensation, liability, material damage, property, subrogation, medical/dental, disability/life, etc. The claim units investigate, evaluate and settle claims in an equitable manner, serving the interests of the Company, policyholder and claimant while providing superior customer service.

Receives claims assignments from manager and directly from the claims system. Verifies coverages and investigates losses by gathering pertinent information.

Takes recorded statements, obtains pertinent information i.e., police and medical reports, appraisals, estimates, photographs, degree of disability, rehabilitation potential, etc., and evaluates damages/eligibility for benefits, determines liability and sets reserves.

Evaluates claims and charges submitted by insureds and medical providers to determine eligibility for benefits, checking for misrepresentation, preexisting conditions and mandated state benefits if applicable.
Documents all decisions, correspondence, reports and discussions that occur during the investigation. Confers with higher level technical claims personnel for guidance and direction to ensure the file is handled properly.
Completes claims by evaluating the loss and settling the claims. Denies coverage where coverage does not exist. Determines if subrogation exists and takes steps necessary for recovery. Within assigned authority limits, settles and pays claims. Coordinates the payment of benefits with other insurance carriers if applicable. Monitors claim files during initial and residual periods to ensure file currency.

Refers the payment or denial of claims that exceed assigned authorization limits to Senior Claims Representative or Claims Manager with settlement recommendation. Detects potential problems or trends that require additional review, investigation or research and refers to Senior Claims Representative or Claims Manager for resolution.

Works closely with health facility, repair facility and/or contractors to facilitate necessary services or repair work. Advises the Claims Department of any special problems i.e., questionable repair shops. Notifies Underwriting of any adverse findings on a particular risk. Accurately codes data submitted to outside agencies or other Sentry functions.

In litigation situations, provides pertinent background information to legal counsel and assists as possible in reaching an in-court or out-of-court settlement.

Participates in administering fraud control procedures, evaluating and preparing reports, and drafting responses to formal complaints.

Performs other job-related duties i.e., receiving telephone claim reports, resolving complaints, completing assigned projects, requiring the same general knowledge, skill and degree of responsibility commensurate with the assigned level.Job Requirements
Qualifications
Knowledge of insurance policies and coverages, claim payment procedures, and familiarity with medical terminology is highly desirable. Previous insurance experience and/or coursework is beneficial. Must possess analytical abilities to review, exercise judgement, and evaluate claims to make sound decisions. Must have self-initiative. Must be able to review and interpret complex and detailed documents such as contracts, medical reports and insurance regulations. Effective oral and written communication skills and human relations skills are critical. Ability to maintain confidentiality is critical. Personal computer and math skills are helpful. NC Adjuster's license is required.

Compensation and Benefits
The starting salary can be up to $40,430 annually depending on experience and qualifications.


Group Health And Dental Insurance

Prescription Eyewear Plan

Group Life Insurance

401(K) Plan With Matching Funds

Retirement Plan

Paid-Time Off Or Time Away From Territory Plan

Pretax Dependent Care And Health Expense Reimbursement Accounts

Student Loan Program

Credit Union

Career Education

Equal Employment Opportunity
It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

Careerbuilder related terms: Agency Sales, Property and Casualty, American Family, State Farm, Progressive, Geico, Account Representative, AIG, Allstate, Federated, Universal Underwriters, Farm Bureau, Farmers, Nationwide, Liberty Mutual, St. Paul Travelers, Claim Representative, Claim Technician, Auto.