Basic Function – Handles initial losses where injuries are reported.
Independently investigates the facts of loss, determines and verifies coverage and liability, evaluates settlement value and settlement options and negotiates injury claims within authority granted. Bodily injury claims handled are generally lower level injury claims.
Injury claims with substantial damage and/or exposure exceeding authority granted may be handled, with oversight, and incumbent will recommend plan of action to resolve any coverage, liability, and damage or settlement issues to next level of file supervision.
Claims handled will require independent analysis and research to resolve coverage, liability, damage and settlement issues.
Responsible for maintaining and growing a relationship between GMAC Insurance and current policyholders. Also responsible for focusing on the needs of loss participants. Identifies customer needs and works to meet those needs using appropriate Point Of Difference skills.
Duties and Responsibilities – For all duties and responsibilities, incumbent will take ownership of any issue, problem, or error that could potentially impact the policyholder and/or loss participant.
1. Develop a basic understanding and knowledge of state laws and regulations applicable to claims handled, including state unfair claim practice laws, and exhibit the basic ability to independently interpret these laws and regulations as it relates to handling of bodily injury claims assigned.
2. Receives initial claim assignments, investigates and confirms coverage and documents basis for granting of coverage. Supervisor may be involved with review of claims to ensure that they are commensurate with ability. 10%
3. Establishes liability investigation plan with the MD TCR; may assist in the investigation by gathering facts and evidence with all witnesses and interested parties; takes recorded statements when necessary; may analyze extent of property damage. Reviews loss reserves and adjusts or opens hidden exposures as necessary. 10%
4.Determines if potential subrogation or fraud issues exist and refers to appropriate claim Unit for handling, with recommendation on plan of action, or may independently determine to handle issues to conclusion.
5. Gather, analyze and evaluate, for settlement purposes, all supportive medical documentation (may include obtaining medical authorizations, medical and lost wage records as necessary). 20%
6. Must understand GMACI Claim Handling Guidelines and exhibit the ability to independently interpret and apply these guidelines to all claims handled.
7. Independently resolves coverage, liability and damage issues, establishes settlement value and negotiates claim to conclusion on all claims within authority granted. For claims with value exceeding authority granted, incumbent will recommend a plan of action for resolution of the claim to manager for approval. 25%
8. Determines and documents basis of settlement value, settlement options, release documents needed, parties needed to conclude settlement and plan of action to negotiate settlement. Makes contact with appropriate party (is) to negotiate a settlement and obtains all necessary settlement documents to conclude settlement and claim. 25%
9. Performs other projects and assignments as agreed upon with designated claims management. 5%
10. May handle more complex files and / or litigation with appropriate supervision. Incumbent will recommend a plan of action for resolution of the claim to appropriate supervisor for approval. 5%