Senior Claims Representative, Bodily Injury

Plymouth Rock Assurance; Parsippany-Troy Hills (NJ); Sur place; USD 88 000 - 112 000; Plein temps

Avantages offerts par ce poste

4 weeks PTO + 9 paid holidays

Low-cost health insurance (Day 1)

401(k) employer contribution

Free onsite gym

Professional development support

Tuition reimbursement

Résumé du poste

Plymouth Rock Assurance is seeking a Casualty Claim Representative to handle First- and Third-Party Bodily Injury claims in a Personal Lines/Commercial setting. You will initiate contact, review policies, conduct field investigations, and manage outside vendors to bring claims to conclusion.

The role requires strong knowledge of litigation, subrogation, and negotiations, with a focus on timely reserve management and adherence to state regulatory guidelines.

Qualifications

• Bachelor's degree in a four-year college or university.
• 5-10 years’ experience handling liability commercial, homeowners, UM/UIM, Excess/Umbrella.
• In-depth knowledge of litigation, arbitration and trial process, handle out of state claims, and/or Personal Injury Protection claims.
• Currently holds and/or can readily obtain an out of State License(s). Professional designation such as CPCU or related preferred.
• High level of self-motivation and strong communication, organizational, and time management skills.
• Knowledge of state laws and regulatory claim handling guidelines and statutory regulations.

Responsabilités

• Initiate prompt contact of insureds/claimants/witnesses on all new claim assignments and conduct thorough investigations.
• Analyze, review and interpret policies to assess coverage and liability and provide advice on excess and primary coverage issues.
• Conduct field investigations and interviews with insureds, witnesses and claimants.
• Manage outside vendors to determine necessary investigations and guide them to resolution.
• Investigate cases timely to establish and adjust reserves as developments occur.
• Investigate bodily injury claims for potential fraud and refer to SIU as needed.
• Handle complex claims including coverage issues, UM/UIM, TNC, Commercial, Umbrella, etc., with prior litigation experience.
• Negotiate 1st and 3rd party claims directly with injured parties or attorneys.
• Attend litigation proceedings and participate in arbitrations, depositions, settlements, and trials.

Connaissances

Claims investigations

Litigation knowledge

Negotiation

Medical terminology

Subrogation

Communication skills

Time management

Regulatory compliance

Formation

Bachelor's degree

Outils

Excel

Word

Social media

Description du poste

The Casualty Claim Representative will be responsible for the handling of First- and Third-Party Bodily Injury claims in a Personal Lines/Commercial environment for the Plymouth Rock Operation.

RESPONSIBILITIES

• Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims.
• Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues.
• Conduct field investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented and unrepresented claimant cases.
• Manage and direct outside vendors (Field/Counsel/Surveillance, etc.) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only necessary work is completed.
• Investigate cases timely so that reserves are established and maintained at proper levels. Revise reserves timely based on developments in the course of the claim.
• Investigate the validity of bodily injury claims being presented by individual insureds/claimants or attorneys representing insureds/claimants. Be aware of certain “Red Flags” to identify potential fraudulent claims. Refer to SIU for investigation timely.
• Handle complex claims to include coverage issues, UM/UIM, TNC, Commercial, Umbrella etc. Also, must have prior litigation handling.
• Recognize and investigate subrogation potential.
• Negotiate both 1st and 3rd party claims directly with injured parties and/or their attorneys.
• Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution.
• Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials.
• Attend all internal and external training events as required.
• Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management.
• Utilize all claims systems, Excel, Word and social media search engines.
• Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtable discussions.
• Effectively manage workload while maintaining diary and focus on claims quality.
• Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
• Adhere to departmental internal control requirements. Comply with Plymouth Rock’s standards, best practices and ethical guidelines, adhere to Plymouth Rock’s culture.

QUALIFICATIONS

• A bachelor's degree (B.A.) from an accredited four-year college or university.
• 5 - 10 years’ experience handling liability commercial, homeowners, UM/UIM, Excess/Umbrella.
• In-depth knowledge of litigation, arbitration and trial process, handle out of state claims, and/or Personal Injury Protection claims.
• Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.). Professional designation such as IIA, AEI, Senior Claim Law Associate (SCLA) or Chartered Property Casualty Underwriting (CPCU) or be actively working towards a designation, preferred.
• High level of self-motivation.
• Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation.
• Strong communication, organizational, customer service and time management skills.
• Excellent problem solving skills.
• Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.

SALARY RANGE

The pay range for this position is $88,00 to $112,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.

PERKS & BENEFITS

• 4 weeks accrued paid time off + 9 paid national holidays per year, and 2 floating holidays
• Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
• Annual 401(k) Employer Contribution
• Free onsite gym at our Woodbridge Location
• Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
• Robust health and wellness program and fitness reimbursements
• Various Paid Family leave options including Paid Parental Leave
• Tuition Reimbursement

ABOUT THE COMPANY

The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.