PRIMARY PURPOSE:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary
• Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
• Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
• Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
• Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion
• Identify customer needs and work to meet those needs using appropriate customer service skills
• Develop an understanding of the functions of other departments, such as Policy Ops and Marketing

Level I

• Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability
• May handle more complex files with appropriate supervision to develop skills
• Develop a working knowledge of systems and technology used within the company

Level II

• Claims involved frequently require analysis and may require research to resolve coverage and/or damage issues
• Periodic review of ongoing activities and results of work
• Focused supervision on complex files; the CRII will handle complex files on a regular basis)
• Receive claim assignments and verifies/investigates coverage and documents all appropriate information
• Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file
• If handling PIP may participate in investigations of medical providers and attend EUOs
• May work with attorneys in resolving lawsuits
• Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level
• Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
• May assist in training of Claims Representatives
• Proficient in using all systems and technology used within the company
• May be required to make personal appearances on behalf of the company when requested

Senior

• Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement
• May inspect damaged property during an investigation
• May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files
• May assist in training and development of other team members or serve as a mentor for others  
• May assist with file reviews and audits
• Proficient and able to train others in using all systems and technology used within the company
• May be required to make personal appearances on behalf of the company when requested
• May also assist manager with preparing reports and completing projects

MINIMUM SKILLS AND COMPETENCIES:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
• Successfully completes Claim Representative trainee program, or equivalent external training program
• Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Obtain/Maintain appropriate licensing or educational requirements 
• Demonstrate proficiency in file audits to agreed standard of efficient claims quality
• High degree of initiative, mature judgment, and discretion
• Ability to resolve conflicts and empathize with customers is critical
• Strong negotiation skills
• Demonstrate professional oral and written communication skills
• Organization and time management skills are critical for this position
• Demonstrate an understanding of insurance law as it relates to claims

Level I

• Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
• Has a basic command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
• Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files
• Can handle most types of comprehensive losses (theft, fire, and vandalism), accurately identify total losses

Level II

• Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
• Has a solid command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
• Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures

Senior

• Demonstrate the capability of consistently handling aggregate file exposures of at least $15,000
• Has thorough knowledge of claims policies and procedures in resolving claims and/or providing technical direction to claims representatives
• Often a source of direction for others on claim policies and procedures
• Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine action plan, and rarely requires assistance on complex claims
• Demonstrate thorough understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, and other potential exposures
• Demonstrate the ability to find answers to more complex issues with insurance law and may be a source of direction / assistance for other representatives
• Demonstrates effective leadership and mentoring skills

DESIRED SKILLS:

• Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
• Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing
• Proficient in systems and technology used within the company (i.e. XactContents)

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National General is a leading insurance carrier which has been in the industry since 1939. Through subsidiaries and other affiliated companies, National General offers homeowners, flood, personal and commercial auto, RV, motorcycle, life, accident and supplemental health insurance products. National General Insurance is a thriving company committed to ensuring that our employees achieve their personal best. Our employees are advancing their careers at a best-in-class insurance provider that is an industry leader in innovation. We give employees resources which enable them to take charge of their own future success.