ESIS Claims Specialist, AGL

JOB DESCRIPTION

The AGL Claims Specialist: Under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Duties may include but are not limited to:


* Receive assignments.


* Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.


* Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.

to secure necessary claim information.


* Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.


* Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract.


* Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.


* Sets reserves within authority limits and recommends reserve changes to Team Leader.


* Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.


* Prepares and submits to Team Leader unusual or possible undesirable exposures.

Assists Team Leader in developing methods and improvements for handling claims.


* Settles claims promptly and equitably.


* Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.


* Informs claimants, insureds/customers or attorney of denial of claim when applicable.


* May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.

Continues efforts to settle claims before trial.


* Refers claims to subrogation as appropriate.

May arrange for salvage disposition or other recovery proceedings as necessary by line of business.


* May participate in claim file reviews and audits with customer/insured and broker.

Administers benefits timely and appropriately.

Maintains control of claim's resolution process to minimize current exposure and future risks


* Establishes and maintains strong customer relations

Depending on line of business, other duties may include:


* Maintaining system logs


* Investigating compensability and benefit entitlement


* Reviewing and approving medical bill payments


* Managing vocational rehabilitation

QUALIFICATIONS



* College degree or 7+ years' experience handling claims in a relevant line of business including Construction Defect claims.


* Basic knowledge of claims handling and familiarity with claims terminologies


* Effective negotiation skills


* Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc....