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Inside Claims Representative

Company: Acuity Mutual
Location: Sheboygan
Posted on: August 2, 2019

Job Description:

OverviewAcuity is seeking an Claims Representative to promptly investigate assigned claims to determine specifics surrounding a loss. This includes phone contact with involved parties, as well as obtaining information via phone, fax and e-mail from agents, doctors, attorneys and other external parties involved in the claim. The claims investigation and evaluation process includes determining coverage under the insurance policy, evaluating liability, assessing damages, and forecasting reserves. Upon completion of the investigation, the Inside Claims Representative will settle meritorious claims within their authority.ResponsibilitiesESSENTIAL FUNCTIONS:



  • Proactively investigate, evaluate and resolve assigned multi-line property and liability claims within multiple state venues.
  • Make timely initial contact with parties involved in the claim, particularly claimants and insureds.
  • Accurately evaluate policy coverage by applying claim facts to the policy contract terms.
  • Consistently forecast reserves, by setting reserve initially with proper reserve coding and monitoring reserve adequacy throughout the course of the claim, consistent with Acuity's reserve philosophy.
  • Thoroughly investigate assigned claims by conducting phone interviews, obtaining recorded statements, securing photos, and obtaining written reports and/or documents.
  • Maintain a personal follow-up task on all claim files to assure timely, proactive handling, efficient claim file organization, quality customer service, and proper management of pending claims.
  • Accurate and thorough claim file documentation, to consistent of timely entry of activity log entries, claims system screen updates, and imaged documentation.
  • Identify potentially fraudulent claims and promptly refer suspect claims to the Special Investigations Unit (SIU).
  • Participate in internal claims phone queue as assigned.
  • Employ and manage outside vendor resources in a cost effective manner.
  • Participation in after-hours pager duty rotation, triaging after- hours and emergency new loss reports.

  • Utilize sound judgment and discretion with settlement authority to properly and effectively resolve claims through negotiation, settlement or denial.
  • Successfully handle litigation files according to company guidelines.
  • Periodically participate in off-hours storm claims duty as dictated by storm claims volume.
  • Maintain a positive, professional attitude.
  • Engage in claims educational opportunities, both in-house and external, as sponsored by management.
  • Always represent Acuity in a professional manner
  • Regular and predictable attendance
  • Perform other duties assigned


    QualificationsEDUCATION:

    College degree or equivalent relevant experience.

    EXPERIENCE:

    Prior claim handling experience preferred.

    OTHER QUALIFICATIONS:



    • Excellent written and verbal communication skills.

    • Proven organizational and time management skills.
    • Proficient in current computer technology

    • Ability and willingness to provide quality customer service
    • Strong analytical and creative problem solving abilities
    • Ability to work both independently and in collaboration with others

      This job is classified as exempt.

Keywords: Acuity Mutual, Sheboygan , Inside Claims Representative, Other , Sheboygan, Wisconsin

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