BI Telephone Claims Representative Trainee, I, II, Sr.

Company: National General
Location: Ontario
Posted on: May 3, 2021

Job Description:

Job Description

Primary Purpose:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. Claims involved are usually subject to standardized procedures which lead to a settlement with limited exercise of discretion. Claims involved occasionally require analysis and may require research to resolve coverage and/or damage issues. There is supervisory review of ongoing progress and results of work. There is more focused supervision on all complex files.

This is NOT a remote position. The right candidate will report to the Ontario, California office (post-COVID-19).

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.

• 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
• 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
• May handle more complex files with appropriate supervision to develop skills
• Develop a working knowledge of systems and technology used within the company
• Identify customer needs and work to meet those needs using appropriate customer service skills

Required 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 the capability of consistently handling aggregate file exposures of at least $2,500
• Demonstrate proficiency in file audits to agreed standard of efficient claims quality
• 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

Keywords: National General, Ontario , BI Telephone Claims Representative Trainee, I, II, Sr., Other , Ontario, California