索赔代表II - 密歇根州
Claim Representative II - Michigan
SUMMARY:
索赔代表 II：
这是索赔处理员职业路径的中级职位。处理中等至复杂的索赔案件。在确定索赔可赔付性方面拥有越来越多的自主权。在确定索赔准备金时考虑诸多因素。在授权范围内协商并解决索赔。远程工作，偶尔需要前往投保市政机构进行现场访问。需居住在密歇根州
RESPONSIBILITIES/TASKS:
- 验证所报财产和意外损失的保险覆盖情况。
- 通过彻底调查索赔和适用的免责条款，确定 covered claims 的责任。
- 根据密歇根州市政责任法规和判例法分析索赔责任。
- 根据索赔的性质，在授权范围内及时建立适当的准备金，基于预期的财务风险。
- 记录可能有代位追偿的索赔细节，包括潜在追偿金额。
- 管理财产、意外和汽车索赔的估价和发票，并根据显示与损失原因及法律责任关系的支持文件批准付款。
- 在索赔解决后结案，以满足内部绩效标准，同时遵守州立法以避免处罚并管理费用。
- 在授权范围内尽早与律师或受伤方协商解决，使案件最终结案。
- 与经理密切合作处理复杂案件或超出赔偿/准备金权限的案件。
- 管理外部供应商以确保成本控制。
- 建立并维护与所有内部和外部客户的有效工作关系。
- 关注市政责任法规和判例法的变化，以便准确解释和应用相关法律。
ADDITIONAL RESPONSIBILITIES/TASKS:
- 在授权范围内处理复杂索赔和灾难性风险，包括来自重点大客户的索赔。
- 独立判断在调解或诉讼前解决案件。
- 积极参与代理/客户关系管理。
- 协助指导团队成员。
此职位描述列出了该职位通常需要履行的责任和任务。可能还需要其他相关的重要职能。
EMPLOYMENT QUALIFICATIONS
EDUCATION
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SUMMARY:
Claim Representative II:
This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Works remotely with occasional travel to on-site visits with insured municipalities. Is a resident in the State of Michigan
RESPONSIBILITIES/TASKS:
- Verifies coverage of claimed property and casualty damage.
- Determines liability for covered claims by thorough investigation of the claim and applicable exclusions.
- Analyzes liability for claims pursuant to Michigan municipal liability statutes and caselaw.
- Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
- Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
- Manages estimates and invoices for property, casualty and automobile claims, and approves payments based on support showing relationship to the cause of loss and legal liability for payment.
- Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
- Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
- Works closely with manager on complex files or files above settlement/reserve authority.
- Manages outside vendors to ensure cost containment efforts.
- Establishes and maintains effective working relationships with all internal and external customers.
- Stays abreast of changes in municipal liability statutes and case law in order to accurately interpret and apply relevant laws.
ADDITIONAL RESPONSIBILITIES/TASKS:
- Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
- Exercises independent judgment to settle cases prior to mediation or litigation.
- Actively participates in agent/client relationship management.
- Assists in mentoring team members.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS
EDUCATION OR EQUIVALENT EXPERIENCE:
Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
EXPERIENCE:
Claim Representative II:
Three years experience in property and casualty claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing policy coverages and exclusions, drafting coverage letters, investigating and settling property and casualty losses, and adjusting claims through litigation and trial. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Ability and proficiency in the use of computers and company standard software specific to position.
- Knowledge of medical and legal terminology related to the work.
- Knowledge of Michigan municipal liability.
- Knowledge of best practices for adjusting property losses.
- Effective oral and written communication skills.
- Effective customer service skills.
- Ability to negotiate, build consensus and resolve conflict.
- Ability to manage multiple priorities and meet established deadlines.
- Attention to detail and analytical skills.
- Ability to work independently as well as within a team.
ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Claim Representative II, III:
- Ability to make independent decisions.
- Ability to solve complex problems.
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards. Minimal travel required.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $56,700 - $94,900.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
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Originally posted on Himalayas