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MD Telephone Claims Representative II

Company Direct General
Location Tampa, FL
Update 7 Day ago
300
Primary Purpose:

Examines claims data, investigates the facts of loss, determines coverage and liability, and adjusts claims within limit of authority. Claims involved frequently require analysis and may require research to resolve coverage and/or damage issues. There is periodic review of ongoing activities and results of work. There is more focused supervision on complex files (The CRII will handle complex files on a regular basis).

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
  • Receive claim assignments and verifies/investigates coverage and documents all appropriate information
  • Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file
  • Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; and review loss reserves and adjust or open hidden exposures as necessary
  • Evaluate and adjust claims within limit of authority
  • Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
  • Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; documents all file activity and payment/settlement information in file notes clearly outlining basis for settlement
  • Determine subrogation or fraud potential and refer to Unit when potential exists or handles to conclusion
  • If handling PIP may participate in investigations of medical providers and attend EUOs
  • May work with attorneys in resolving lawsuits
  • Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level
  • Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
  • May assist in training of Claims Representatives
  • Perform other projects and assignments as directed
  • Is proficient in using all systems and technology used within the company
  • May be required to make personal appearances on behalf of the company when requested
  • Identify customer needs and works to meet those needs using appropriate customer service skills

Required Skills and Competencies:

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.
  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
  • Successfully completes Claim Representative trainee program, or equivalent external training program
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Obtain/Maintain appropriate licensing or educational requirements
  • Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
  • Demonstrate proficiency in file audits to agreed standard of efficient claims quality
  • Has a solid command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
  • Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files
  • Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures
  • For claims involving injuries, has solid understanding of how to review, evaluate, and negotiate injury claims
  • Demonstrate ability to handle litigation in accordance with company guidelines, and be able to recognize legal issues and will utilize ADR when appropriate
  • High degree of initiative, mature judgment, and discretion
  • Ability to resolve conflicts and empathize with customers is critical
  • Strong negotiation skills
  • Demonstrate professional oral and written communication skills
  • Organization and time management skills are critical for this position
  • Demonstrate an understanding of insurance law as it relates to claims
  • Begin to develop effective leadership skills in order to mentor other adjusters, function as a team leader, handle projects, etc.

Desired Skills:
  • Demonstrates a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
  • Demonstrates an understanding of the functions of other departments, such as Policy Ops and Marketing

Job Requirements

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About National General Holdings:

National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

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