Basic Function - Independently investigates the facts of loss, determines and verifies coverage and liability, evaluates settlement value and settlement options and negotiates material damage claims within authority granted.
Claims involved occasionally require independent analysis and research to resolve coverage, liability, damage and/or settlement issues.
Responsible for maintaining and growing a relationship between National General 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 customer service 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 material damage claims.
2. Receives initial material damage claim assignments, investigates and confirms coverage, and documents basis for granting of coverage. Supervisor may be involved with review of claims to ensure they are commensurate with ability.
3..Establishes liability investigative plan; initiates investigation by gathering facts and evidence with all witnesses and interested parties; completes appropriate reports; takes recorded statements when necessary and analyzes extent of property damage. Reviews loss reserves and adjusts or opens hidden exposures as necessary.
4. Gather, analyze and evaluate, for settlement purposes, all supportive material damage documentation and adjusts material damage claims within limit of authority granted. Summarizes and recommends plan of action on material damage claims in excess of authority and submits to manager for approval.
5. Must understand National General Insurance Claim Handling Guidelines and exhibit the ability to independently interpret and apply these guidelines to all claims handle
6. 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.
7. Makes appropriate contacts to discuss a settlement; extends an offer to appropriate party; documents all file activity and payment/settlement information in file outlining basis for settlement and obtains all necessary settlement documents to conclude claim.
8. 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.
9. May handle more complex files with appropriate supervision to develop skills.
10. Performs other projects and assignments as agreed upon with appropriate level of management.