Claims Representative I

This position can be remote or hybrid.

SUMMARY:
Review and analyze routine first party homeowner’s claims to determine extent of insurance carrier’s liability, determines the extent of damaged property, and recommends settlement amounts in order conclude claims with policyholders in accordance with policy provisions and applicable insurance statutes and laws.
The objective is to obtain appropriate license to adjust losses, complete training modules and mentorship with colleague which includes handling a claim form beginning to end. This will primarily be claims which are less complex in nature, involving theft, lightning and small structural losses. These losses require limited investigation and are generally lower dollar value claims. In assisting mentor, the trainee will become familiar with the process for more complex losses requiring additional investigation and review. The trainee period is generally designed to be three to 12 months (but not limited to) and at the conclusion of that time, individual should be able to handle claims of light nature independently.

ESSENTIAL DUTIES AND RESPONSIBILITIES Other duties may be assigned.
(INVESTIGATION)

• Reviews the insurance policy, endorsements, and related information in order to make a coverage determination.
• Conducts the appropriate claim investigation and directs the investigation of any assigned resources.
• Obtains any physical evidence, develops third party information and theory of liability, conducts recorded interviews, and secures official records.
• Recognizes and submits subrogation, underwriting and SIU referrals as necessary.
• Maintains file documentation, file notes and investigation documentation on each assigned claim in accordance with company guidelines.

(DECISION MAKING)

• Reviews policy, adjusters’ reports, damage estimates, expert reports and any other documentation needed to make the appropriate coverage and loss decisions to conclude assigned claims.
• Able to write/create/edit simple estimates based on customer’s information or independent adjuster’s information utilizing computerized estimating system.
• Able to write/create/edit letter to confirm status or decision.
• Makes recommendations and decisions based on claim documentation and investigation.

(COMMUNICATION)

• Provides prompt service to policyholders utilizing phone, fax, mail and electronic mail. Communicates with all customers in a professional manner.
• Complies with customer service objectives (as determined by the company)
• Communicates with Claims Supervisors consistent with company guidelines.

(LICENSURE)

• Successfully completes training and maintains FL License by meeting Continuing Education requirements.
• Operates in accordance with Florida Statues
• This job has no supervisory responsibilities; however, Claims Representatives will communicate expectations and oversee all vendors involved in the claim investigation.

PM19Requirements:
College degree (four-year college/university) or equivalent professional education and experience combined; and a minimum of 1 year professional experience is preferred; successful completion of our initial training program consisting of insurance principles, loss adjustment basics and basic residential construction.
Knowledge of personal line property forms, ability to read and interpret documents such as insurance contracts, structural estimates, expert reports, construction codes, safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively in person and on the telephone.
COMPUTER SKILLS
Proficient with the Microsoft Office Suite including, Word, Excel, and Power Point. Individual must be able to create presentations using Power Point and other available software and equipment. Basic working knowledge of Symbility or Xactimate estimating software.
Computer and computer program utilization, ability to calculate figures and amounts, such as, square footage, linear feet, overhead and profit, sales tax, actual cash value, interest, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to define problems, collects data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Good communication and interpersonal skills, customer service oriented, empathy, pays attention to detail, shows strong initiative, organizational skills, and has the ability to learn. Ability to deal at times with stressful situations in a professional and non-combative manner.
Provide support to other members of the technical claims staff.
Participates in CAT Duty as required.
Other duties as determined by management.
Insurance adjusters license State of Florida (520 license).