Claims Representative

Job Description

Job Description

Description : Job Summary :

Responsible for managing mitigation losses in accordance with authority level.

General Duties and Responsibilities :

• Applies and follows all customer service, restoration claim, and Company policies and procedures, including script adherence.
• Provides prompt and efficient contact with the policy holder and dispatch a certified contractor to the premises for arrival within company guidelines.
• Actively manages claims to mitigate damage for insurance carriers and expedite closure of claims.
• Confirms damages, DOL and other conditions and circumstances of the loss with the insured.
• Verifies status of claim with Insurance Carrier (e.g. covered loss).
• Works in a partnership with assigned contractor, discussing job scope with lead technician, evaluates reported water readings, and updates claim with appropriate notes. Creates the invoice based on authorized services required to mitigate the loss.
• Holds contractors to industry standards to ensure an appropriate drying plan is put into place.
• Sends initial report to carrier and initial scope estimate to contractor.
• Comes to agreed scope on day one and holds contractor accountable for deviations.
• Escalates potential coverage concerns, or special drying situations to carrier / management.
• Reviews claim for necessary hazardous material testing.
• Communicates with client to recommend reserve amount based on exposure, advice of subrogation potential, possible fraud or unusual underwriting risk.
• Interprets, analyzes and assists with customer inquiries which may vary in nature.
• Provides prompt and efficient responses and resolutions to each inquiry in a courteous and professional manner, regardless of how the inquiry is received (e.g. : in-bound call, claim alert, email, fax, or electronic data interchange).
• Provides technical information required to respond to customer inquiries by phone, mail, and / or email.
• Enters data and other relevant information into client claims database or other business applications, as required completely and accurately.
• Understands and ensures that quality standards are met per company guidelines.
• Assists all departments in a courteous and professional manner to reach business goals and objectives.
• Participates in individual and team trainings and meetings to ensure accurate information is relayed to customers / clients and individual performance is maximized.
• Performs follow-up in accordance with documented and / or stated guidelines.
• Works with and maintains professional relationships with Insurance Clients, Insureds, co-workers, and contractor personnel to ensure callers are receiving proper service.
• Adheres to assigned work schedule.
• Exhibits a professional image and behavior.
• Is available to work flexible hours, including nights, weekends, and overtime when required.
• Meets or exceeds benchmarked metrics (metrics are subject to change as our business needs / model changes) designed to measure productivity and / or quality per company guidelines.
• Completes Xactimate / Symbility files as needed.
• Reviews claim timeline to ensure accuracy.
• Reviews claim security settings.
• Submits invoice, claim summary, and documentation to carrier as necessary.
• Works directly with Supervisor to ensure claims progress as planned.
• Follows personal growth path to progress towards becoming a Claims Analyst within the time frame set by management.
• Performs other duties as assigned.

Job ID : INDACSJ

Requirements :

Minimum Qualifications :