Sr. Claims Representatives (Phoenix - East Valley)

Summary:   Responsible for providing excellent customer service in the handling of first and third party property damage, bodily injury and some litigated claims from start to finish.  Develops resolution plans to address complex customer complaints. Claims will be handled in a phone-adjusting environment using Preferred shops, Field Appraisers, and approved Independent Adjusters for all property damage exposures. Needs to understand coverage, policy interpretation, exposure recognition, liability determination, and adjusting bodily injury claims at all levels of the claim. Additional required skills will encompass salvage, subrogation, and litigation handling.

 

 

Job Description: 

 

? Properly document files to include all key activities, contacts made, statements taken, including a full outline covering all aspects of the claim and what is needed for resolution

? Proficiently navigate through XPM, Filehandler, DocFinity, Process Claims, ISO and CCC to process and resolve the claim and order appropriate reports

? Analyzes facts of loss, injury, and possible exposure potential  greater than $25,000 prior to review with management for potential triage

? Evaluates bodily injury claims up to $25,000 with ease which could include severe head trauma, loss of consciousness, and multiple fractures with extended recovery times

? Acknowledges time-limit demands, documents and contacts attorneys appropriately

? Negotiates bodily injury claims with claimant attorneys to include workers? compensation and other potential liens

? Exhibits proficiency in receiving and negotiating liens with healthcare providers and worker?s compensation carriers for first and third party injury claims 

? Processes medical payment claims at $25,000 or higher independently

? Reviews medical records and bills to validate accuracy of services provided

? Completes detailed BI evaluation summary in documents as stated in prior levels

? Determines if treatment is reasonable for the type of diagnosis, impact, and characteristics of the injured party

? Identifies and refers high exposure files for triage

? Refers claims through the Defense Referral Process

? Identifies referrals, completes proper summaries and forwards files to subrogation for collection in a timely manner

? Reviews subrogation demands and estimates up to $15,000 prior to sending demand to the MD Auditor for estimate review

? Monitors repairs and customer rentals to ensure timeliness with repair process

? Highly proficient handling claims involving issues such as denial of coverage, excess coverage, reduction of policy limits for unlisted drivers and multiple policy coverage.





 

 

Qualifications:



 

? Bachelor?s degree and/or a minimum of 2 years of customer service experience is required

? Prior personal auto claims experience with skills as described is required

? Excellent verbal, written and interpersonal skills

? Strong analytical skills

? Organizational and multi-tasking abilities

? Solid negotiation skills

? Exceptional customer service skills

? Team player who can assist others as needed

? Solid computer skills and use with MS Office Products

 

 

If you'd like to be a part of a team that is revolutionizing the way people think about insurance, please submit your resume to us by clicking on the following link: