Job Purpose 

The Claims Representative is responsible for the investigation, management, negotiation, and resolution of claims in accordance with policy provisions, compliance, best practices and jurisdictional requirements. Responsibility also encompass the input of claims data and guiding insureds and claimants through the claim process and the recognition of life events, customer’s needs, as well as, providing advice to deliver appropriate solutions.  

Scope of Accountability and Duties

The following does not represent an exhaustive list of responsibilities, duties, and/or skills; 

· Will manage, investigate, evaluate, negotiate and resolve claims to its resolution. 

· Must exhibit the ability to multi-task and prioritize work load in a goal oriented environment. 

· Effectively communicate with policyholders, witnesses, and claimants to gather information regarding claims. 

· Responsible for all aspects of each claim; including informal hearing arbitration and small claims litigation as designated by PCG and/or its clients. 

· Must maintain a high level of productivity, confidentiality, and customer service while using discretion and independent judgement in claims handling.  

· Must demonstrate functional knowledge and skills reflective of a fully competent claims representative. 

· Will log and maintain file notes per carrier guidelines. 

· Will be required to complete other job duties as assigned by Manager. 

Qualifications 

Education: Minimum High School Diploma or GED required.

Work Experience: 1- 5 years of claims experience required.

Computer/Software: Proficient in the use of applicable claims handling systems and software.

Experience using MS Word, Outlook, PowerPoint, and Excel. 

Licenses: Must possess valid adjuster state license(s) as defined by company. 

Competencies  

To perform this job successfully, an individual must be able to perform the essential duties satisfactorily. 

The requirements listed below are representative of the knowledge, skills, and/or abilities required.  

· Strong insurance knowledge in property-casualty insurance industry. 

· Technical claims expertise. 

· Maintenance of licenses and/or the ability to obtain appropriate adjuster licensing in assigned states. 

· Experience working in a client support environment. 

· Proficient in the use of applicable claims handling systems and software. 

· Experience using MS Word, Outlook, Power Point and Excel. 

· Ability to collect, analyze and evaluate information. Ability to communicate clearly. 

Working Conditions and Physical Requirements 

· Operate a computer terminal/PC equipment and telephone equipment within an office environment.

· Operate a computer terminal/PC equipment and telephone equipment within an office environment. 

· Must be able to remain in a stationary position for the majority of an assigned shift/schedule. 

· Will need to occasionally move about inside the office to access file cabinets, office machinery, etc. 

· Must be able to work weekends, nights, and/or on call as regular part of this position. 

· This position frequently communicates with customers who have inquiries concerning all aspects of the insurance claims process, as such, one must be able to exchange accurate information in all situations.