Senior Claims Representative, Casualty

Plymouth Rock Assurance; Port Reading (NJ); On-site; USD 81,000 - 105,000; Full time

Benefits offered by this job

Paid time off

Health insurance

401(k)

Onsite gym

Licensure assistance

Wellness program

Paid parental leave

Job summary

Plymouth Rock Assurance is seeking a Senior Casualty Claim Representative to handle First- and Third-Party Bodily Injury and Physical Damage claims in a Personal Lines/Commercial environment. The role requires strong investigation, negotiation, and subrogation skills, with familiarity in state laws and regulatory guidelines.

The position involves managing complex claims, supervising outside vendors, and maintaining reserves while ensuring timely and accurate resolution.

Qualifications

• Bachelor's degree required from an accredited four year college or university.
• 3-5 years' experience handling liability and/or Personal Injury Protection claims.
• 4+ years of experience handling bodily injury or casualty claims.
• Some litigation experience and knowledge of the New Jersey court system preferred.
• Out-of-state license(s) such as CT, Delaware, Florida, preferred.

Responsibilities

• Initiate prompt contact of insureds/claimants/witnesses on new claim assignments and conduct coverage and liability investigations.
• Analyze, review and interpret policies to assess coverage and liability; provide advice on excess and primary coverage issues.
• Conduct investigations and interviews; manage outside vendors to determine necessary investigations.
• Investigate cases timely to establish reserves and revise them as needed.
• Negotiate 1st and 3rd party claims; participate in litigation proceedings as required.

Education

Bachelor's degree from an accredited four year college or university

Job description

The Senior Casualty Claim Representative will be responsible for the handling of First- and Third-Party Bodily Injury and Physical Damage claims in a Personal Lines /Commercial environment for the Plymouth Rock Operation. The candidate must have the skills listed below and be able to perform the following duties

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.
• Willing to conduct investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented 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.
• Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation. Handle more complex claims to include coverage issues, UM/UIM, etc.. Also, must have prior litigation handling.
• Recognize and investigate subrogation potential.
• Negotiate both 1st and 3rd party claims directly with injured parties 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.
• Possess strong organizational skills, able to demonstrate time management, has the ability to prioritize multiple tasks/duties, and be proficient in the utilization of all claims systems, Excel, Word and social media search engines.
• Have strong communication skills both verbal and written. Provide strong customer service. Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtables.
• Capable of working independently without close supervision, high level of self motivation, effectively manage workload while maintaining diary and focus on claims quality.
• Ability to handle multiple responsibilities and be adept at conflict resolution while working in a team environment. Work well under pressure. Able to think strategically, solve problems, set priorities, make the necessary decisions to resolve complex/regular issues/claims.
• 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.
• 3 - 5 years' experience handling liability and/or Personal Injury Protection claims.
• 4+ years of experience handling bodily injury or casualty claims.
• Some litigation experience and knowledge of the New Jersey court system is preferred.
• Knowledge of PA, CT or NY claims handling would be beneficial.
• Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.) is preferred

The pay range for this position is $81,000 to $105,000 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
• 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