What are the responsibilities and job description for the Claim Representative position at AMERIND?
Position Characteristics and Competencies
- Excellent time and project management skills
- Meticulous attention to detail
- Proficiency with industry-related software applications
- Excellent customer relations skills
- Ability to provide transparent information and demonstrate high customer service
- Problem-solving and analytical thinking
- Strong verbal and written communication skills
- Ability to handle multiple tasks simultaneously
- Interest in discovering and developing new ideas
- Agile and adaptable decision-making
- Team collaboration
- Good fundamental understanding of insurance policy terminology
- Dependable and reliable
- Familiarity with technology infrastructure and user of technology tools
Job Summary
Evaluates property insurance claims for Commercial and Homeowner business lines, ranging from level 1 to level 3 total losses. Assesses property claims for coverage and reaches a resolution with the policyholder. Collaborates with third-party and independent companies as necessary to investigate claims properly; reviews third-party field reports, conducts site investigations and utilizes specialized software like Xactimate and Xactanalysis to generate field reports. Oversees the claim process from start to finish and ensures all relevant information is gathered accurately and efficiently.
This job description does not represent an inclusive list of all duties encompassed in this position.
Job Responsibilities
Property Essential Duties of Claim Representative
- Determines Coverage Evaluation, which includes the following:
- Establishing and Adjuster reserves for the claim file
- Customer communication, whether it is completed by phone or written (email or by letter)
- Evaluating policy coverage for the risk.
- Evaluating field reports of the damage risk.
- Obtaining additional risk information.
- Inputting all risk information into the claim system
- Securing a resolution payment for the policyholder
- Preparing the claim file for closure
- Communicates with customers and associates over the telephone, in person, and in written correspondence.
- Investigates claims on-site, evaluating damages, completing coverage analysis, damage assessments, and cause/origin determination, and submits a field report with a narrative, estimate, photos, and any other pertinent information for the damages.
- Determines property damage evaluation using Xactimate software, negotiates settlements, and approves supplement expenses.
- Prepares declination letters when coverage is not applicable under the policy.
- Prepares correspondence letters to policyholders with updates on their claims, including settlement explanations and closure letter summaries.
- Obtains any supporting documents for the claim file.
- Within department guidelines and metrics, manages daily work assignments and correctly closes claim files. Performs subrogation and recovery of property claims where there is another responsible party.
- Maintains claim files and other related documents per best practices.
- Performs a wide variety of typing assignments that are sometimes confidential in nature; operates personal computer to enter data, draft, edit, revise, and print letters, tables, reports, and other materials.
- Maintains professional and technical knowledge by obtaining certificates and designations: AIC, Property Technical Certificate (PTC 1-2-3), Water Damage Restoration Tech Certificate, Property Examiner, Residential Estimating, California Earthquake of Flood Adjusting courses from accredited institutions.
- Maintains confidentiality of all information.
- Participates in cross-functional team process improvement projects.
- Performs other duties as assigned.
Supervision of Others
N/A
Minimum Qualifications
- An Associate Degree in Insurance, Economics, Business Administration, or a related field is required. A bachelor’s degree in insurance, Economics, Business Administration, or a related field is preferred.
- Designations and certificates from accredited insurance institutions are preferred.
- Minimum of three years of desk adjusting experience involving property claims preferred.
- Minimum of three years of field adjusting experience using software applications such as Symbility, Xactimate, or Xactanalysis preferred.
- A minimum of three years of carrier risk information system, such as Guidewire or Sapiens, is preferred.
- Field assignments may require frequent, short-notice travel for extended periods.
- Valid Driver’s License required
- Must be able to pass a background investigation successfully.
- Must be able to travel 30% as needed.
Additional Eligibility Requirements
- New employees must complete the Associate in Insurance (AINS) designation within six months from the end of the 90-day evaluation period to be eligible for advancement and incentive compensation.
- For continued employment, employees must complete an elective course and six hours of professional development within 12 months after the end of the 90-day evaluation period.
Knowledge/Skills/Abilities
- Knowledge of applicable federal, state, tribal, and local laws, regulations, and requirements.
- Knowledge of property, auto, and liability insurance laws, policies, and regulations.
- Knowledge of medical and insurance terminology, and of claims processing practices.
- Knowledge of Homeowner and Commercial policy forms.
- Knowledge of evaluating third-party field information and finalizing coverage evaluation and resolution for the claim file.
- Knowledge of occupational safety theory, procedures, and equipment.
- Ability to successfully obtain certificate(s) in Property Technical Certificate (PTC 1-2-3) upon employment.
- Ability to interpret insurance policies, claim procedures, and federal and state regulations. Ability to communicate effectively in the English language, both verbally and in writing.
- Ability to analyze situations and adopt appropriate courses of action.
- Ability to work effectively under stressful conditions.
- Ability to interact and maintain good working relationships with individuals of varying social and cultural backgrounds, employees and officials.
- Ability to develop and interpret policies, procedures, and regulations.
- Ability to maintain an accurate and organized filing system of complex insurance records and reports.
- Ability to handle multiple tasks and meet deadlines.
- Ability to exercise independent judgment.
- Ability to train and present information to others.
- Ability to follow oral and written instruction.
- Ability to collect and analyze data, prepare and present accurate reports and recommendations.
- Ability to act with integrity and maintain confidentiality.
- Skill in performing statistical and mathematical computations.
- Skill in preparing, presenting, reviewing, and analyzing insurance claims, forms, and reports.
- Skill in providing excellent customer service.
- Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and presentation software (such as PowerPoint).
- Database management skills
- Excellent telephone communication skills.
Working Conditions & Physical Demands
- Typical business office setting with moderate noise level and outdoor settings with a high noise level.
- A non-office environment may be encountered for offsite presentations and support of company activities.
- Exposure to natural weather conditions and temperatures, various dusts, smoke and mists, and normal debris and hazards may occur while performing outdoor duties.
- Must be able to work at a computer and phone for more than 6 hours per day.
- Must be able to speak clearly.
- Must be able to use hand for dexterity of motion.
- Frequently required to stand, walk, and reach with hands and arms.
- Must have the ability to occasionally lift 20 lbs.
- Must have ability to climb ladders for property inspections.
- Must be willing to travel as necessary; COVID-19 vaccination preferred.
Physical Exam
Employee is required to successfully pass an annual physical exam to certify that the incumbent is capable of performing the physical demands of the job.
