PRIMARY PURPOSE:

Responsible for performing structured reviews of claim files to assure that they meet defined file quality standards as defined by internal and external requirements, in an objective and consistent manner for the Claims Department. Claim file reviews will address opportunities to improve and provide feedback in a positive learning environment, with the goal being continuous improvement. This position is remote.

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.

• Complete assigned audits accurately and within a set time period
• Participate in special events and audits as needed
• Conduct calibration discussions with managers to ensure the Claim Department has consistency in understanding and application of file handling expectations
• Respond to claim’s leadership questions and inquiries in a timely manner with accuracy
• Participate in intra-team calibration sessions to ensure necessary calibration is included in this function
• Maintain monthly and quarterly reporting with management over the assigned region and specialty, including assessment of action items and evaluation of action plans; expertise and utilization of the audit tool is necessary
• Interpret and apply coverage issues accurately with a full understanding of the requirements surrounding good faith file handling
• Communicate effectively with all levels of employees, from front line claims representatives to department and company leaders

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.

• Proficient in the property and casualty claims handling process, including most or all product lines and coverages
• Thorough knowledge of policies & procedures, claims handling processes, and state legal and regulatory issues
• Solid knowledge in any combination of the following technical areas: coverage and liability assessment, material damage estimatics, property/homeowners and/or RV. ADVANCED CASUALTY (BODILY INJURY), LITIGATION AND PIP CLAIMS HANDLING EXPERIENCE AND EXPERTISE.
• High degree of initiative, mature judgment and discretion
• Ability to resolve conflicts and empathize with others through negotiation
• Effective business planning and time management skills with the ability to work under pressure, adhere to project deadlines and assume leadership role as needed
• General understanding of global company knowledge and totality of impact of decisions
• Solid understanding of the insurance industry and organizational relationships of the company
• General understanding of the functions of other departments (i.e. Policy Ops, Marketing, Finance)
• Basic skills in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Must possess effective verbal and written communication skills
• Ability to travel on occasion, sometimes with limited notice

DESIRED SKILLS:

• Advanced casualty (bodily injury), litigation and PIP claims handling experience and expertise
• Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
• Expert knowledge in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• 5+ years of experience in Insurance Claims