Insurance Claims Representative Job Description

INSURANCE CLAIMS REPRESENTATIVE SUMMARY OF FUNCTIONS

Investigates claims for personal, casualty, or property loss or damages; determines the extent of the insurance company’s liability; and tries to negotiate an out-of-court settlement with the client.

INSURANCE CLAIMS REPRESENTATIVE ESSENTIAL DUTIES AND RESPONSIBILITIES

• Quickly and effectively investigates claims, negotiates equitable settlements and authorizes prompt payments to policyholders.
• Reviews insurance forms for accuracy and completeness. Calls or writes to the insured party or others involved to secure missing information.
• Reviews the claim file and the insurance policy to determine coverage. Transmits routine claims for payment; informs claims supervisor of those claims needing further investigation.
• Investigates claims as necessary, through use of physical evidence, securing testimony from relevant parties, and examining reports.
• Promptly negotiates settlements, making sure that the settlement reflects the actual claimant losses while also being certain that the insurer is protected from invalid claims.
• Attends court hearings if litigation becomes necessary.

ORGANIZATIONAL RELATIONSHIPS

Reports directly to Claims Supervisor. Works with Insurance Agents, clients, other insurance companies to resolve claims.

INSURANCE CLAIMS REPRESENTATIVE QUALIFICATIONS

A bachelor’s degree in business administration or suitable field of study is required. Coursework in insurance studies is a plus, as is claims handling experience. Good grammar and written/oral communication skills are required. Familiarity with word processing and spreadsheet applications (e.g., MS-Office) is also required. Experience with claims processing software is desired.

INSURANCE CLAIMS REPRESENTATIVE PHYSICAL DEMANDS

Automobile travel to customer sites is required (about 50%). Must be able to communicate orally with customers, management, and other co-workers, both individually and in front of a group. Regular use of the telephone and e-mail for communication is essential.

Sitting for extended periods is common. Hearing and vision within normal ranges is essential for normal conversations, to receive ordinary information and to prepare or inspect documents.

No heavy lifting is expected. Exertion of up to 20 lbs. of force occasionally may be required. Good manual dexterity required to use common office equipment (computer, mobile device, calculator, copier/scanner, fax machine, etc.

Good reasoning, organizational, and time management skills are required to solve a wide range of business problems. Must also be able to understand and utilize insurance and financial reports and legal documents to conduct business.

WORK ENVIRONMENT

The job is performed indoors in a traditional office setting, at claimants’ sites, in auto, etc.  Activities include extended periods of sitting (at office, in auto) and extensive work with computers, mobile devices, and other productivity tools.