Senior Claims Resolution Specialist

JOB OBJECTIVE:

Investigate, evaluate, negotiate and settle commercial auto casualty claims and any related coverages within established best practices and applicable jurisdictional guidelines.

ESSENTIAL FUNCTIONS:

• Investigate, evaluate, settle and process claims primarily on the phone with limited in-person contact.
• Handle claims including injury and third party property damage claims primarily under personal and commercial auto and garage, uninsured and underinsured motorists, homeowners liability and commercial liability coverages. Claims will generally range from low to moderate severity and may involve disability, wage loss and hospital treatment.
• Handle automobile physical damage claims in conjunction with material damage appraisers.
• Comply with the claims organization's policies, established best practices and jurisdictional guidelines.
• Comply with practices and procedures for contact and communication, verification of coverages, determination of liability, investigation of losses, and determination of claims values, completion of forms and reports, negotiation and settlement of claims.
• Comply with all state Fair Claims Practices acts and obtain state licensing as required.
• Maintain competency in the use of multiple claims systems and manage efficient and effective follow-up practices.
• Effectively investigate and handle a minimum average of 42 losses per month.

OTHER FUNCTIONS:

• Maintain an ongoing understanding of claims processes, procedures and systems, and keep current on fair claims practices laws, compliance issues, and business-related developments.
• Make limited outside contacts at the discretion of the casualty team lead.
• Perform other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• The candidate must have previous experience as a Claims Resolution Specialist or its equivalent in the industry.
• Due to the complexity of the work performed and the frequency of customer contact, experience in successfully working with customers is strongly desirable.
• Experience may be achieved in part or in full through the following: Sales experience, public service experience (e.g., police, social work) and/or other professional-level business experience.
• Continuing education during the first two years of employment is preferred and may be obtained through the following: In-house claims training classes, The Institutes (Associate in Claims (AIC) and/or Chartered Property Casualty Underwriter (CPCU) designations) or other accredited insurance education provider.
• This position requires excellent knowledge of all company commercial auto and commercial garage policies and coverages.
• The individual must understand tort law, be familiar with medical terms and treatments, and be able to effectively negotiate settlements.
• Demonstrate the skills and abilities listed in the Claims Resolution Specialist job description.
• A college degree and the ability to read, write and speak fluent Spanish are strongly desired.

This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.