Senior QA Claims Representative - Inside


Job Title: Senior QA Claims Representative - Inside

Department: Claims

Reports To:  Claims Management 

FLSA Status:  Exempt

Prepared By:  Jason Neville

Prepared Date: August 20, 2015

SUMMARY 

 Essential role that supports the Claims Department goal to be a best-in-class organization by focusing on, participating in, measuring and improving all aspects of quality, production and customer service.  Primary focus will be participation in the Claims Quality Assurance process, serving as a corporate representative for litigated claim depositions and attending DFS mediations.       

ESSENTIAL DUTIES AND RESPONSIBILITIES 

 Essential duties and responsibilities include but are not limited to the following: 

  • Reviews claims related work product to verify customer service, investigation, documentation, analysis, estimatics, resolution and leakage avoidance standards are met.
  • Conducts detailed file reviews, interviews, audits and other quality verification focused tasks on property & casualty insurance claim files, staff and vendors.
  • Reviews existing or prepares comparison damage estimates using computer-estimating software.
  • Serves as a corporate representative by sitting for litigated claim depositions.
  • Participates in the Florida DFS Mediation process on behalf of the company.
  • Makes decisions and recommendations based on objective investigation and documentation.
  • Maintains documents, notes and materials in accordance with company guidelines.
  • As needed, maintains an open claim inventory in accordance with company guidelines.
  • Provides prompt service to internal and external customers and other parties by utilizing in-person interaction, telephone, fax, mail and electronic mail. Communicates with all parties in a professional manner.
  • Communicates with Supervisors and others consistent with company guidelines.
  • Operates in accordance with Florida Statues as well as all other relevant laws, rules, etc.
  • Maintains appropriate Adjuster License by adhering to Continuing Education requirements, rules, etc.

SUPERVISORY RESPONSIBILITIES 

 Quality Assurance functions will include claim file reviews, customer service evaluations and review of other work product quality indicators.    

 Senior Representatives may be asked to provide training, direction and leadership to other staff.

QUALIFICATIONS 

 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily on a consistent basis. 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.

EDUCATION AND/OR EXPERIENCE 

 College degree (four-year college/university) or equivalent professional education and experience combined; minimum 5 years related adjusting experience; and successful completion of the initial claims training program, advanced training courses as outlined in the extended training catalogue, and/or optional successful completion of a company sponsored insurance designation.  

LANGUAGE SKILLS 

 Ability to read and interpret documents such as insurance contracts, structural estimates, expert reports, construction codes, safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write detailed and specific reports and correspondences.  Ability to speak effectively in person and on the telephone. 

MATHEMATICAL SKILLS 

 Ability to calculate figures and amounts such as discounts, commissions, proportions, percentages, overhead and profit, sales tax, actual cash value, interest, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.

 BEHAVIORAL STRENGTHS 

Good communication and interpersonal skills, customer service oriented, pays attention to detail, shows initiative, possesses organizational skills, and has the ability to learn.  Works well with limited supervision.  

 OTHER RESPONSIBILITIES/REQUIREMENTS

  • Must have a valid driver’s license.
  • May be required to travel.
  • Understanding of property damage estimating fundamentals and software.
  • Participates in CAT Duty as required.
  • Proficient in using computer software applications (Microsoft Office Suite, etc.).
  • Other duties as determined by management.

 CERTIFICATES, LICENSES, REGISTRATIONS 

 Class 520 Insurance Adjusters License.  

 PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 While performing the duties of this job, the employee is regularly required to talk or hear.  The employee frequently is required to sit; use hands to finger, handle, or feel; and reach with hands and arms.  The employee is frequently required to stand, walk, climb and/or balance.  The employee must occasionally lift and/or move up to 30 pounds.  Employees should be prepared to work in an outside environment, crawl under homes, and climb on roofs in order to complete inspections.

 WORK ENVIRONMENT

 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 The noise level in the work environment is usually moderate and involves some outside travel.



 


OUR COMPANY


No matter the square footage, your home is your castle. At Tower Hill we’re in the business of protecting castles. We provide the insurance protection you need and the peace of mind you want.

Founded more than 40 years ago, today Tower Hill is Florida’s largest homeowners insurer. Our company is financially strong and solid. We’ve weathered every storm and natural disaster in the state since 1972, and helped our customers rebuild after each one.

Like you, we love Florida. We enjoy the sun when it’s shining, appreciate mild winters, watch out for lightning, and build hurricane kits every summer. And like you, our homes are our castles. Sometimes the unexpected happens — or even the unthinkable — and we understand what that feels like, too. That’s why our 400 employees are committed to being there when you need us all year long, not just during storm season.

Your home is where you and your family should feel safe and protected. You can be confident that if the unthinkable happens, Tower Hill will be there to help you rebuild. When your home truly feels like your castle again to you, we know we’ve succeeded as your insurance company. Although we have grown in size over the last four decades, we remain committed to the promises we made when our company was founded.