Proactively investigates, confirms coverage, determines liability, evaluates damages, and negotiates settlement of Tier 3 auto physical damage and bodily injury claims, which include Auto losses with exposures up to $150,000 requiring in-depth investigation, analysis, evaluation, and negotiation skills. Maintains ownership of claim through resolution of all exposures. Serves as the primary point of contact for customers throughout the claims process. Communicates and collaborates with other claim specialists to facilitate claim resolution for customers.
Makes same day contact with customers.
Explains the claims process to all customers.
Explains all applicable coverage benefits to the policyholder.
Determines vehicle location and if drivable.
Offers vehicle repair and rental service options to customers.
Arranges for auto physical damage estimate through proper method of inspection.
Arranges for release of vehicles that are accruing storage fees.
Arranges for in-person meeting with injured unrepresented claimants based on the needs of the claim.
Investigates and determines coverage for Auto policy claims with coverage issues requiring in-depth investigation including but not limited to policy out of force for the date of loss, unlisted or permissive drivers, excluded drivers, vehicle not on the policy, rideshare involvement, material misrepresentation issues, and new business investigations.
Escalates coverage issues requiring in-depth policy interpretation to supervisor.
Provides verbal and written communication to customers to explain coverage issues and decisions.
Communicates policy risk issues to Underwriting to facilitate their evaluation of the policy risk and exposure.
Investigates and determines liability for claims requiring in depth investigation and analysis including multi vehicle auto losses with comparative negligence.
Completes investigation by securing recorded statements of the parties, police report, vehicle photos and estimates, scene investigations, and other supporting evidence.
Analyzes duties owed and breached by all potential responsible parties and determines liability percentage for each party.
Communicates liability decision to customers, claimants, claim specialists, and Underwriting.
Recognizes subrogation potential and makes referrals to Subrogation department when appropriate.
Investigates and recognizes all potential claim exposures.
Investigates and evaluates injury exposures for all alleged injury claims.
Escalates claims with exposures exceeding financial authority and Tier 3 complexity criteria to Supervisor.
Resolves auto physical damage claims proactively and accurately.
Secures estimate of damages timely through appropriate repair channel.
Coordinates and collaborates with auto physical damage and total loss specialists to facilitate claim resolution for customers.
Explains repair process and estimate to customers.
Manages rental claims through communication with customers, repair facilities, rental vendors, and claim specialists.
Proactively manages and mitigates storage costs.
Issues and authorizes claim payments to customers and repair facilities.
Resolves injury claims proactively and accurately.
Types of injury exposures investigated include but are not limited to exposures up to $150,000, allegations of soft tissue injury, fracture, dislocation, ligament injuries, herniated disc and nerve injuries.
Completes injury investigation by securing recorded statements of injured parties, meeting in person with injured parties as necessary, obtaining signed medical authorizations, and requesting medical bills and records.
Analyzes and evaluates injury causation for all alleged injuries.
Evaluates bodily injury claims early and throughout the life of the claim including assessment of medical damages, wage loss, and general damages. Evaluates, sets, and updates case reserve amount for all injury exposures throughout the life of the claim.
Negotiates settlement of bodily injury claims directly with unrepresented claimants and with represented claimants' attorneys.
Secures signed release of claims and issues payment upon final settlement.
Communicates with insured throughout the claim to keep them informed as to injury claim status.
Maintains active diary and resolution plan on open files.
Manages 80-100% of an average tier 3 workload of auto physical damage and injury exposures.
Handles and documents files in compliance with regulatory requirements.
Responsible for making sure appropriate and professional correspondence is sent to customers including claim status updates.
Prior work experience with demonstrated customer service and time management skills is preferred.
Proficient critical thinking, time management, analytical, and negotiation skills. Proficient in use of computer, internet, and Microsoft office applications.