Claims Specialist II | Northern Neck Insurance

Department: Member Services – Property Claims Field Position
Location: *Fredericksburg/Stafford Area
Reports to: Property Claims Supervisor
Job Level / FLSA: Professional/Managerial #2 / Exempt

Summary

Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal claims of moderate severity and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.

Essential Duties and Responsibilities

Handles 1st party Property claims of moderate severity and complexity as assigned.
Completes desk, virtual, field or vendor assisted inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles.
Negotiates with multiple constituents such as contractors or insureds representatives and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with Best Practices.
Maintains an effective diary system, captures all required data accurately and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Identifies and refers claims with Major exposure or coverage question to the Supervisor.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Actively provides mentoring and coaching to less experienced claim professionals.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Obtains experts as needed.
Other duties as assigned. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.
All employees are expected to participate in catastrophic events.

Skills Required

Must be able to read, analyze and understand technical reports, related documents.
Written, verbal and interpersonal communication skills are required, including the ability to convey and receive information effectively.
Must be able to verbally communicate decisions and negotiate effectively with all Customers, internal and external.
Will be required to possess the skills to author reports and letters that are persuasive and professional.
As most of the contact with Customers is done verbally and via telephone, individual must be able to speak clearly, politely, use proper grammar and terms that are familiar to the general public.
Interpersonal and Customer Service skills a must.
Judgment, analytical, negotiation and decision making skills a must.
Basic typing skills are essential.
Must be able to work independently and manage time well.
Must be able to gather information, establish facts, and evaluate data to determine coverage, liability and damages.
Must be able to apply applicable law, contractual terms and conditions and statutory requirements to the decision-making process.
Basic math skills that will allow preparation and evaluation of damage estimates as well as percentages for depreciation and liability.
This job requires that the employee’s skills are continuously updated to keep abreast of changing policy forms, laws and statutory regulations.

Qualifications

Bachelor’s Degree, or 3 to 5 years’ experience in the Insurance Industry and/or a related technical field.
Property claim handling experience preferred.
Experience in utilizing computer technology; such as Microsoft Office, e-mail, Web-enabled applications, and database software required.
General knowledge of construction, estimating and estimating systems required.

Supervisory Responsibilities

This position has no supervisory responsibilities.

Physical Demands and Work Environment

Most of this job is done in an office environment but may require onsite inspection or travel to meet with Agents, policyholders, claimants and vendors on occasion. The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee will be required to sit, talk, see and hear. The employee is frequently required to use hands to type, key numbers and handle paper documents. This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding, requiring the ability to carry, set up and climb a ladder weighing approximately 30 to 50 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when training or deploying to a catastrophe. In the field there will be occasional exposure to excess noise, dirt, dust, fumes, smoke, gases, mold or other irritating substances. There will be frequent exposure to variable weather conditions.