Field Claims Specialist II, MD
LOCATIONS:
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JOB SUMMARY: Investigates, evaluates, negotiates and brings to a final resolution personal lines material/physical damage of a moderate to severe nature. Promotes and provides ""On Your Side"" customer service. Responsible for the handling of claims in accordance with prescribed authorization and claims best practices.
Job Description
RELATIONSHIP: Reports to Reports to Claims Manager
DIRECT REPORTS: None
JOB RESPONSIBILITIES:
Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Determines proper policy coverages and applies best claims practices to conclude assigned cases in accordance with company guidelines. Adheres to high standards of professional conduct while providing delivery of superior claims service.
Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. In accordance with Corporate Reserving Guidelines. Adheres to file conferencing notification and authority procedures.
Maintains current knowledge of insurance and applicable product/services; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars and/or training sessions.
Maintains current knowledge of local industry repair procedures and local market pricing.
Submits severe incident reports, reinsurance reports and other information to claims management as needed.
Partners with SIU and Subrogation to identify fraud and subrogation opportunities.
Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management.
Other duties as assigned.
JOB REQUIREMENTS:
Education: Undergraduate degree or equivalent experience.
Licenses/Designations: State licensing where required. Successful completion of required/applicable claims certification training/classes. Professional development such as IIA or CPCU preferred.
Experience: Three to Five years successful experience in customer service and/or claims handling required. Material/physical damage experience preferred. Related repair industry experience a plus.
Knowledge: Demonstrated knowledge of customer service principles. Insurance company operations and multiple property casualty insurance lines of business. Material/physical damage repair processes, vendor management, customer service techniques, and all related claims systems. Demonstrated knowledge and adherence to best claims practices. Participation in technical insurance or industry coursework preferred (CPCU, ICAR, ASE)
Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Excellent customer focus and proven ability to proactively meet customer needs. General knowledge of insurance theory and practices, insurance contracts and their application. Familiarity with claims processing and claims best practices and procedures preferred. Proven knowledge of insurance contracts, medical terminology, workers compensaiton, and the legal aspects of court procedures affecting legal liability for all lines of insurance. Knowledge of claims systems.Proven analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to establish repair requirements and cost estimates for extensive losses and serves as a subject matter expert on respective claims projects. Proven organizational skills to effectively prioritize increased and more complex workloads.Demonstrates strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants,attorneys, agents, and general public. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. Ability to operate a PC and related software.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.
JOB CONDITIONS:
Working Conditions: Field or office claims environment. May require ability to sit and operate telephone and personal computer for extended periods of time. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be able to make physical inspections of accident scenes. Must be able to climb, balance at various heights, stoop, bend, and/or crawl to inspect vehicles and structures. Must be able to work out of doors in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple onsite responsibilities and/or for extended periods of time. Extended and/or non-standard hours as required.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Job Evaluation Activity: Edited 5/2/11 JTG
Additional Job Description
This field opportunity will be staffed in the San Jose, CA territory. This position comes with a company vehicle that may be used for personal, as well as business use.
Nationwide offers a competitive salary and benefits package that includes PTO, a flexible schedule, medical, dental & vision coverage, 401(k) match and a pension plan.
Ideal candidates will have outstanding time management skills and strong communication skills. Material damage and estimating background is ideal, but not necessary.
#claims
Job ID: 53604
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