Claims Representative

SUMMARY
Investigate, negotiate and settle claims of a more serious nature within personal settlement
authority under general supervision. Render prompt claim service and establish the best possible
relationship with all persons involved.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

May be responsible for the set-up of claims including taking loss reports, establishing a claim
file either through automated or manual systems and obtaining policy information through the use of
computer or direct contact with agents or company personnel.

Performs a thorough investigation of the loss including securing recorded or signed statements,
medical records and reports, proof of loss, police reports, diagrams, photographs or testimony from
technical experts. Investigation may be tedious and involve the exploring of less accessible
sources.

Secure assistance of specialists or outside vendors where personal judgment dictates the cost
effectiveness and need for these services.
Interprets coverage and liability issues on the majority of cases seeking advice on only the most
involved cases or those with dollar values exceeding personal authorization. This includes
reviewing policy language and endorsements as well as using reference materials to determine legal
precedent. On claims where investigation warrants denial, prepares denial materials including
documentation and communicates the decision to the affected parties.
Evaluates and appraises losses and applies deductibles, betterment and depreciation principles in
arriving at a settlement amount. This may include writing estimates and acquiring agreed prices for
property damage as well as assessing bodily injury and related awards for personal injury cases.

Reviews all bills and estimates prior to making settlement or seeking settlement authority to
determine applicability for payment under policy provisions.
Prepares drafts, negotiates settlements and performs all tasks required to close a case and effect
efficient and fair settlement of claims. This may include the proper handling of subrogation and
disposal of salvage or property owned by the Company to reduce paid loss amounts.

Prepares all worksheets, forms, documentation and reporting duties to create a file that is capable
of being used by others to monitor progress or continue efficient handling of a claim.
Responsible for providing an acceptable work space to work out of their home and comply with the
Company Telecommuting Agreement.

AUTHORITY
Responsible for settlement of claims within personal authorization. Must follow claim procedures and
applicable legal doctrines, however, uses independent judgment and initiative to obtain results.

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential
duty satisfactorily. 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.

EDUCATION and/or EXPERIENCE
Bachelor Degree or equivalent. Experience at the claim representative level with the ability to handle more
complex cases with only general supervision.

CERTIFICATES, LICENSES, REGISTRATIONS
AIC, Agents Property and Casualty License (by state).

OTHER SKILLS AND ABILITIES
Must be able to readily interpret policy language liability and negligence law on more involved cases and
perform research when required. Work is varied and complex in nature. Must have knowledge of claim
values and establish the value of the majority of assigned cases. Must have knowledge of claim procedures
and legal requirements for proper claim handling. Access and enter information accurately into CRT.
Prepare written worksheets, forms and other documentation to enable efficient claim handling. Record
numerous reports, letters, and file documentation for transcription by appropriate staff. Maintain acceptable
attendance as defined in the company personnel policy.

PHYSICAL DEMANDS The physical demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential functions.