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BI Telephone Claims Representative II

Company: National General Insurance
Location: Miami
Posted on: March 28, 2020

Job Description:

Primary Purpose:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. Claims involved are usually subject to standardized procedures which lead to a settlement with limited exercise of discretion. Claims involved occasionally require analysis and may require research to resolve coverage and/or damage issues. There is supervisory review of ongoing progress and results of work. There is more focused supervision on all complex files.

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.


  • Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability
  • Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may review loss reserves and adjust or opens hidden exposures as necessary
  • Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
  • Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
  • Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
  • Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion
  • May handle more complex files with appropriate supervision to develop skills
  • Develop a working knowledge of systems and technology used within the company
  • Identify customer needs and work to meet those needs using appropriate customer service skills

    Required Skills and Competencies:

    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.

    • Bachelors Degree or in-lieu of degree equivalent education, training and work-related experience
    • Successfully completes Claim Representative trainee program, or equivalent external training program
    • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
    • Obtain/Maintain appropriate licensing or educational requirements
    • Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
    • Demonstrate proficiency in file audits to agreed standard of efficient claims quality
    • Has a basic command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
    • Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files
    • For claims involving material damage, comply with the company material damage guidelines
    • Can handle most types of comprehensive losses (theft, fire, and vandalism), accurately identify total losses
    • For claims involving injuries, have a general understanding of how to review, evaluate, and negotiate injury claims
    • High degree of initiative, mature judgment, and discretion
    • Ability to resolve conflicts and empathize with customers is critical
    • Strong negotiation skills
    • Demonstrate professional oral and written communication skills
    • Organization and time management skills are critical for this position
    • Demonstrate an understanding of insurance law as it relates to claims
    • Demonstrated proficiency with basic computer skills with word processing, spreadsheets, email and internet

      Desired Skills:

      • Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
      • Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing

        National General Holdings Corp. is an Equal Opportunity (EO) employer Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

        In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

Keywords: National General Insurance, Miami , BI Telephone Claims Representative II, Other , Miami, Florida

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