Claims Lead Representative

  • location: Egg Harbor Township, NJ
  • type: Contract
  • salary: $26 - $31 per hour
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job description

Claims Lead Representative

job summary:
Job Title:Claims Lead Representative

9554198

POSITION SUMMARY

Investigates, evaluates, disposes of and settles the most complex and highest exposure claims with minimal supervision, including the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves in accordance with legal statutes, policy provisions and company guidelines.

KEY RESPONSIBILITIES: (Duties may include, but are not limited to, all or some of the following)

  • Understand concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims toward resolution using Best Practices.
  • Promptly investigate all assigned claims for coverage, liability assessment and damages.
  • Manage detailed investigation and negotiations.
  • Investigate claims by interviewing claimants and witnesses, establish claim reserves, handle evidence, obtain evidence, obtain and interpret official reports, medical reports and claim forms, and attend/participate at mediation, trials or hearings.
  • Negotiate and settle claims, set reserves and manage litigation within client service parameters and authority levels by obtaining demands and making offers to claimants.
  • May present evidence at legal proceedings.
  • Direct appraisal and/or inspection of damaged property.
  • Dispose of salvage and pursue subrogation when appropriate.
  • Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
  • Document plan of action in the claim system and set appropriate diaries.
  • Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
  • Close all files as appropriate in a timely and complete manner.
  • Maintain closing ratio as directed by management team.
  • Attend/participate at mediation, trials or hearings.
  • Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors.
  • Perform other duties as required.
COMPENTENCIES

Confidentiality - Possesses high level and regard for confidentiality.

Dependability - Is trustworthy, reliable and accurate.

Detail Oriented - Focuses on details to obtain a quality work product.

Follows Direction - Acts in accordance with instructions.

Judgment - Forms an opinion objectively and with discretion.

Organization - Is able to plan and carry out activities effectively.

Problem Solving - Evaluates information and situations, approaching and resolving in a timely manner.

Teamwork - Promotes cooperation and commitment within a team to achieve goals.

Time Management - Plans and controls time to effectively accomplish goals.

Work Ethic - Is hard working, diligent, reliable, and has initiative.

Skills:

Proficient with MS Excel and Word

Computer experience with related claims software

Excellent verbal and written communication skills

Proven interpersonal skills capable of dealing with all levels of personnel

Exceptional ability to multi-task

Excellent negotiation skills

Superior organizational and decision making skills

Customer-focused orientation

Strong analytical and strategizing skills

Expertise in tort and related claims handling practices and ability to apply same

Deep knowledge of client and carrier claims procedures

Significant understanding of self-insured retention

Excess and reinsurance reporting

Fluent in medical terminology and medical/injury treatments.

Education:

Associates or Bachelor's degree, or five or more years of equivalent work experience required in an insurance/TPA or related industry;

At least 5-6 years of experience handling liability claims required; more experience may be required depending upon complexity of claim pending.

Completion of training courses internally and/or externally in all significant areas affecting claims handling and practices.

Licenses, certifications, awards preferred.

 
location: Egg Harbor Township, New Jersey
job type: Contract
salary: $26 - 31 per hour
work hours: 8 to 5
education: Bachelor's degree
experience: 6 Years
 
responsibilities:
KEY RESPONSIBILITIES: (Duties may include, but are not limited to, all or some of the following)

  • Understand concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims toward resolution using Best Practices.
  • Promptly investigate all assigned claims for coverage, liability assessment and damages.
  • Manage detailed investigation and negotiations.
  • Investigate claims by interviewing claimants and witnesses, establish claim reserves, handle evidence, obtain evidence, obtain and interpret official reports, medical reports and claim forms, and attend/participate at mediation, trials or hearings.
  • Negotiate and settle claims, set reserves and manage litigation within client service parameters and authority levels by obtaining demands and making offers to claimants.
  • May present evidence at legal proceedings.
  • Direct appraisal and/or inspection of damaged property.
  • Dispose of salvage and pursue subrogation when appropriate.
  • Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
  • Document plan of action in the claim system and set appropriate diaries.
  • Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
  • Close all files as appropriate in a timely and complete manner.
  • Maintain closing ratio as directed by management team.
  • Attend/participate at mediation, trials or hearings.
  • Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors.
  • Perform other duties as required.
 
qualifications:
Skills:

Proficient with MS Excel and Word

Computer experience with related claims software

Excellent verbal and written communication skills

Proven interpersonal skills capable of dealing with all levels of personnel

Exceptional ability to multi-task

Excellent negotiation skills

Superior organizational and decision making skills

Customer-focused orientation

Strong analytical and strategizing skills

Expertise in tort and related claims handling practices and ability to apply same

Deep knowledge of client and carrier claims procedures

Significant understanding of self-insured retention

Excess and reinsurance reporting

Fluent in medical terminology and medical/injury treatments.

Education:

Associates or Bachelor's degree, or five or more years of equivalent work experience required in an insurance/TPA or related industry;

At least 5-6 years of experience handling liability claims required; more experience may be required depending upon complexity of claim pending.

Completion of training courses internally and/or externally in all significant areas affecting claims handling and practices.

Licenses, certifications, awards preferred.

Click to Apply

 
skills: Workers Compensation Reporting Claims
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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