Claims Specialist

POSITION TITLE:              CLAIMS SPECIALIST

DEPARTMENT:                  CLAIMS

REPORTS TO:                   CLAIMS DIRECTOR OR DESIGNEE

DATE:                                 DECEMBER 2021

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GENERAL RESPONSIBILITIES:

Within limited authority and under the guidance of the Claims Director or designee, adjusts and settles assigned claims by telephone. Authorizes settlement of all assigned claims within established limits. Is trained in Association claims handling policies and procedures and North Carolina Statutory {G.S. 58-63-15 (11)}Unfair Claims Settlement Practices.  Performs other duties as may be required.

ESSENTIAL FUNCTIONS:

1. Learn coverages starting with DP-1 Policy; learns to read and understand First Notice of Loss;  learn the Associations’ Claims Department service and response standards.

2. Learn about building systems, construction and repair techniques.  Learn costs of building construction components. Learn to use manual and automated cost estimating systems.

3. Learn to make initial telephone contact with policyholder or claimant to determine cause and extent of damages or injuries. Review scope of damages or injuries and obtain sufficient information to resolve claim.

4. Assign claims to an independent adjuster and involve other loss evaluation experts within assigned authority.

5. Learn to make written denial with an explanation to policyholder or claimant on claims for which no coverage is in force.

6. Within assigned authority level, issues loss and expense payments and establish appropriate file and expense reserves on all assigned claims.

7. Properly document all file activity in file notes and other claims related data bases.

8. Learn all aspects of Claims Data Processing. Act in an office support capacity by inputting new claims, reserve changes and checks as required.. Also learn to move documents electronically to the Imaging System.

9. Based upon the authority referred to in Item 6, learn to examine and investigate claim, negotiate, settle claim within established limits after securing proper documentation of the cause and extent of loss, applying policy provisions and exclusions, documenting all file activity and adhering to the Associations’ procedures and time standards.

10. Learn to re-negotiate as necessary any claims settlement, and pays supplemental payments within authority.

11. Learn to evaluate and approve adjuster and other expert expenses within guidelines developed      by the Association .

12. Investigate and evaluate recovery potential, and learn to perform or supervise the performance of all  necessary recovery activities on those claims handled.

13. Review diary and follow up as appropriate.  Learn to prepare production, accuracy and other required reports.

14. Answer routine questions relative to area of responsibility. While Department of Insurance and other complaint letters would be handled by the supervisor, is introduced to the process on assigned claims.

15. Participate in appropriate eduction as identified and assigned by Management.

MINIMUM QUALIFICATIONS:

College degree preferred. In lieu of college degree, progressively responsible experience in liability and/or property insurance  would also be considered, or a combination of post high school education and work experience. Intro to Insurance, Intro to Claims, INS. Course work also considered to offset experience.  Construction estimating experience may be substituted for insurance experience.  Existing agent or adjuster’s licenses desirable.

Ability to clearly communicate information orally and in writing and to deal effectively and diplomatically with a wide variety of people including co-workers.  Prefer terminal keyboard-entry skills equivalent to 45 wpm range.  Must qualify for North Carolina Adjuster's license.

The ability to work with others in a team environment.  The ability to accept direction from superiors.  The ability to follow work rules and procedures.  The ability to accept constructive criticism. 

WORKING CONDITIONS:

Up to one-quarter (1/4) of the time standing and moving about the office.  Travel to outside meetings required, possibly overnight.  May be required to travel to a temporary storm office.  Carrying, pushing, pulling and lifting of equipment and other supplies within the office.  Stooping, kneeling and reaching into shelving or cabinets required.    The office work area is climate controlled and tobacco smoke-free.