Casualty Claims Senior Representative

Westfield Insurance; Westfield Center (OH); Remote; USD 65,000 - 90,000; Full time

Job summary

A leading insurance company is seeking a Casualty Claims Senior Representative to handle claims adjusting in a high-volume environment. The role includes mentoring less experienced team members and entails negotiations, claims investigations, and maintaining high-quality customer service through effective communication and decision-making.

Qualifications

• 4+ years of Claims Handling experience.
• Bachelor's degree in Business, Communication or related field.
• Valid driver's license for field roles.

Responsibilities

• Determines coverage and investigates claims thoroughly.
• Negotiates settlements with various stakeholders.
• Mentors less experienced Adjusters on the team.

Skills

Claims Investigations

Customer Relationship Management

Data Analysis and Reporting

Financial controls

Education

Bachelor's degree in Business, Communication, or a related field

Job description

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Job Summary

The Claims Senior Representative serves as a technical expert on claims adjusting and handles injury, material damage, negligence, compensability, damage, and coverage issues. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Casualty Claims resolves third party liability claims involving injury, property damage, construction defect, personal & advertising injury, and environmental cleanup - both pre-suit and in litigation.

Job Summary

The Claims Senior Representative serves as a technical expert on claims adjusting and handles injury, material damage, negligence, compensability, damage, and coverage issues. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Casualty Claims resolves third party liability claims involving injury, property damage, construction defect, personal & advertising injury, and environmental cleanup - both pre-suit and in litigation.

Job Responsibilities

• Determines whether proper coverage exists for the type of claim assigned.
• Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions on claim resolution.
• Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker.
• Determines the value of the physical damage of property, automobiles, or injuries through appropriate tools, recognizes claim file exposures and escalates appropriately.
• Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies.
• Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets.
• Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards.
• Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience.
• Identifies and refers all claims to management for further handling and assignment instructions.
• Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations.
• Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing.
• Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines.
• Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel.
• Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation.
• Interprets complex and detailed documents such as contracts, legal documents, medical reports, insurance regulations and policies as needed.
• Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices.
  
  

Job Qualifications

• 4+ years of Claims Handling experience.
• Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience.
• For field roles only: Valid driver’s license and a driving record that conforms to company standards.
  
  

Location

Remote

Licenses and Certifications

• Certified Professional Claims Management (CPCM) (preferred)
  
  

Behavioral Competencies

• Collaborates
• Communicates Effectively
• Customer Focus
• Decision Quality
• Nimble Learning
  
  

Technical Skills

• Account Management
• Claims Investigations
• Claims Adjustment
• Financial controls
• Case Management
• Customer Relationship Management
• Project Management
• Business Process Improvement
• Auditing
• Data Analysis and Reporting
  
  

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

About Us

Founded in 1848, Westfield is a global leader in property and casualty insurance, delivering superior risk insights and innovative solutions to customers through a diverse portfolio of insurance products. Westfield underwrites commercial, personal, surety, and specialty lines of coverage through a network of leading independent agents and brokers in the United States and specialty products through Lloyd’s of London Syndicate 1200. As a mutual insurance company with more than 3,000 employees, Westfield has revenues in excess of $4 billion and more than $10 billion in assets.

Equal Opportunity Employer

United States: All applicants receive consideration for employment without regard to race, color, sex, religion, national origin, age, sexual orientation, gender identity, disability, or status as a protected veteran.

United Kingdom: Westfield is committed to equality of opportunity for all staff and applications from individuals are encouraged regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy and maternity, race, religion or belief and marriage and civil partnerships.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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