- Conduct and coordinate investigations on all assigned claims.
- Negotiate the settlement of claims within assigned authority.
- Maintain accountability for all assigned claims until disposition is reached.
- Document all activity on assigned claims and assure control of independent vendors.
- Review new losses and files on diary to ensure reserve adequacy while keeping management informed of adverse developments.
- Monitor loss adjustment expense and take steps to contain file expenses.
- Utilize vendors judiciously to maximize value added.
- Review coverage questions and work with supervisor and claim management for approval.
- Refer appropriate coverage matters to the Team Leader, Claim Supervisor or Manager.
- Ensure appropriate file handling, documentation, reporting, and expense control.
- Provide accurate and timely information to all external and internal customers concerning claim status and other claim inquiries.
- Meet with policyholders and agencies as needed.
- Attend trials, depositions, EUO's, appraisals and mediations where beneficial or required.
- Suggest improvements of processes within the department to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, etc.
- Participate in setting file direction and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting.
- Deliver technical training for agents, peers and clerical personnel upon request.
- This position directly handles an assigned claim caseload.
- Performs other duties or special projects as required or as assigned.
- Bachelor's degree in business, insurance or a related field, or its equivalent; two or more years of relevant claim technical experience; or a combination of education and experience from which comparable knowledge and skills are acquired.
- Appropriate state Adjuster's License(s) where required by law.
- For field based positions, previous outside experience is preferred and valid driver's license is required.
- Sound knowledge of the technical aspects of property and/or casualty claims related to the core responsibilities expected of the position.
- Demonstrated commitment to professional development through continuing education related to the job such as AIC, AEI, INS, SCLA or CPCU certification coursework, etc.
- Developing skills in specialized technical disciplines; including working knowledge of relevant contract and tort law.
- General understanding of the insurance industry and company operations.
- Solid analytical, and negotiation skills.
- Good verbal and written communication skills.
- Ability to exercise sound judgment in dealing with professional situations and confidential information.
- Ability to work effectively with a wide range of outside firms and organizations.
- Ability to deal effectively with company management peers and support staff.
- Strong customer service orientation.
- Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); imaging and estimating programs.
- Ability to perform job duties under stressful conditions.
- Perform other duties or special projects as required or assigned.
- Typical office, field or residence based working environment.
- For field based positions, regular outside automobile day travel of approximately 50% is expected.
- For non-field positions, predominately sedentary office position with high frequency of keyboarding/computer work required.
- Occasional overnight travel.
- Potentially subject to adverse weather and stressful situations with respect to claim disputes.
-
Claims Representative
2 weeks ago
Sedgwick Montpelier, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Claim Representative
3 weeks ago
Vermont Mutual Montpelier, United StatesJob Description · Job DescriptionDirectly handle a technical claims caseload of a specific nature. Caseload typically comprised of files arising from a limited range of coverage's and possessing up to moderate financial exposure The primary emphasis is on producing thorough, accu ...
-
Sr. Claim Representative
3 weeks ago
Vermont Mutual Insurance Montpelier, United StatesDirectly handle a diverse claims caseload including multiple coverage feature types and a large percentage of losses of moderate to high complexity and financial severity. Claims assigned occasionally involve substantive coverage issues or litigation. Employee should possess demo ...
-
Sr. Claim Representative
1 week ago
Vermont Mutual Montpelier, United StatesJob Description · Job DescriptionDirectly handle a diverse claims caseload including multiple coverage feature types and a large percentage of losses of moderate to high complexity and financial severity. Claims assigned occasionally involve substantive coverage issues or litigat ...
-
Claims Research
1 week ago
Humana Montpelier, United StatesBecome a part of our caring community and help us put health first · Humana/iCare is seeking a Claims Research and Resolution Representative 2 to join our growing team. This position is responsible for researching, examining and responding to claims processing issues in a timely ...
-
Insurance Professional Trainee Program
1 week ago
Vermont Mutual Montpelier, United StatesJob Description · Job DescriptionWe are pleased to offer a training program for individuals setting their career sights on the insurance industry. This robust program includes the training, mentorship and on the job training for Candidates to be successful as either a Claims or U ...
-
L & A Claims Examiner I
3 weeks ago
National Life Group Montpelier, United StatesLife and Annuity Claims Examiner I · National Life Group · At National Life, do work that matters in a culture where people matter. Join a growing organization where our people have been bringing peace of mind to families and our communities for 175 years. · Claims Team · Our ...
-
L & A Claims Examiner I
1 week ago
National Life Group Montpelier, United StatesLife and Annuity Claims Examiner I · This position is located on our Montpelier, VT or Addison, TX campus. · National Life Group · At National Life, do work that matters in a culture where people matter. Join a growing organization where our people have been bringing peace of ...
-
Claims Team Manager
3 weeks ago
National Life Group Montpelier, United StatesClaims Team Manager · National Life Group · At National Life, do work that matters in a culture where people matter. Join a growing organization where our people have been bringing peace of mind to families and our communities for 175 years. · Claims Team · Our Claims Team is ...
-
Program Technician II
2 weeks ago
State of Vermont Montpelier, United StatesOverview · The Vermont Department of Labor posting is seeking a Program Technician II to work in the Unemployment Insurance Quality Control Unit. The Program Technician provides support to the Quality Control Unit by assisting in the administration of quality control review prog ...
-
Customer Support Tech
2 weeks ago
Union Mutual of Vermont Companies Montpelier, United StatesJob Description · Job DescriptionUnion Mutual Insurance Company is currently recruiting for the right candidate to join our Company as a Customer Support Technician. The Company will consider hybrid work arrangements after the first few months of employment. · The Customer Suppor ...
-
Program Technician II
3 weeks ago
State of Vermont Montpelier, United StatesOverview · The Vermont Department of Labor posting is seeking a Program Technician II to work in the Unemployment Insurance Quality Control Unit. The Program Technician provides support to the Quality Control Unit by assisting in the administration of quality control review progr ...
-
Senior Medical Stop Loss Underwriter
6 days ago
Highmark Health Montpelier, United StatesHighmark Health · Senior Medical Stop Loss Underwriter · Montpelier , · Vermont · Apply Now · This job prices quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ...
-
UC Program Administrator II
3 weeks ago
State of Vermont Montpelier, United StatesOverview · The Unemployment Insurance Division is seeking a highly motivated individual with strong supervisory background to assist in the planning, coordination, and supervision of various sections within the Division. This includes planning, assigning, supervising, and reviewi ...
-
senior manager, r&d strategic finance
2 weeks ago
National Life Group Montpelier, United StatesThis senior level incumbent will handle large face amount cases, while interacting with field personnel, and other more junior underwriters. Primary role will be to provide accurate and timely risk assessment and evaluation of life applications, renewals, or cancellations utilizi ...
-
Senior Underwriter
4 days ago
National Life Group Montpelier, United StatesSenior UnderwriterThis position is located on our Montpelier, Vermont or Dallas, Texas campus and candidates must be able to work onsite at one of those locations in a hybrid role. There are no remote opportunities at this time.This senior level incumbent will handle large face a ...
-
Market Conduct Examiner
5 days ago
State of Vermont Montpelier, United StatesOverview The Market Conduct Examiner (MCE) performs highly complex work involving planning and coordinating market conduct examinations of insurers. Market conduct examinations are done under the direction of the Director of Market Regulation (Director) and require significant in ...
-
Senior Analyst
6 days ago
Health Services Advisory Group Montpelier, United StatesHealth Services Advisory Group, Inc. · Senior Analyst - REMOTE - 1033/704/3812_ _ · Montpelier , · Vermont · Apply Now · This job was posted by : For moreinformation, please see: Job Details · SUMMARY · HSAG is nationally recognized as an industry leader in the areas ofhea ...
-
Market Conduct Examiner
1 week ago
State of Vermont Montpelier, United StatesOverview · The Market Conduct Examiner (MCE) performs highly complex work involving planning and coordinating market conduct examinations of insurers. Market conduct examinations are done under the direction of the Director of Market Regulation (Director) and require significant ...
-
Market Conduct Examiner
1 week ago
State of Vermont Montpelier, United StatesOverview · The Market Conduct Examiner (MCE) performs highly complex work involving planning and coordinating market conduct examinations of insurers. Market conduct examinations are done under the direction of the Director of Market Regulation (Director) and require significant ...
Claim Representative - Montpelier, United States - Vermont Mutual Insurance
3 weeks ago
Description
Directly handle a technical claims caseload of a specific nature. Caseload typically comprised of files arising from a limited range of coverage's and possessing up to moderate financial exposure The primary emphasis is on producing thorough, accurate and courteous claims adjustments for our policyholders and claimants. Such claims infrequently involve substantive coverage issues or litigation. Reasonably conclude claims promptly and equitably within the provisions of the insurance policy and in accordance with known damages and legal requirements. All files handled will comply with claim file handling guidelines and all other job expectations, regulations and requirements.
DUTIES & RESPONSIBILITIES
The Claim Supervisor or Team Leader provides direct moderate to minimal supervision.
SUPERVISION EXERCISED
This job has no supervisory duties; however limited supervision of independent adjusters, appraisers and vendors may occur.
QUALIFICATIONS
