Insurance Claims Investigator
Primary Purpose: Investigates insurance claims; obtain all necessary information to evaluate claims and expedite settlement.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Investigate out of state insurance claims within limits of authority; responsible for the accurate and efficient completion of all phases of claims processing from inception to settlement.
- Obtain (via telephone or correspondence) loss reports, insured/witness/claimant statements, medical/police reports, appraisals, repair estimates, etc., as required; take photos as indicated.
- Confirm coverage for new claims and set reserves amounts; follow up on necessary information; and record diaries for scheduled review of files; issue payment & correspondence as needed.
- Analyze all accumulated data, reports, photos, etc. and evaluate claims; determine coverage and extent of loss/liability; prepare corresponding claims summaries.
- Settle claim within limits of authority; issue drafts/checks for claim payment and obtain required liability releases; upon settlement, close claims files.
- Confer with Out of State Claims Manager regarding complex claims or when potential exposure exceeds settlement authority.
- Periodically review all open out of state claims files; obtain any necessary information and adjust reserve amounts as needed.
- Make assignments to independent adjusters as necessary; be vigilant in using independent adjusters only for those investigation activities which cannot be done by telephone or by correspondence.
Competencies To perform the job successfully, an individual should demonstrate the following competencies:
- Analytical
- Customer Service
- Interpersonal Skills
- Oral Communication
- Written Communication
- Business Acumen
- Ethics
- Organizational Support
- Judgment
- Planning/Organization
- Professionalism
- Quality
- Quantity
- Safety and Security
- Adaptability
- Attendance/Punctuality
- Dependability
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience Bachelor's degree from four-year college or university; or two to four years related experience and/or training; or equivalent combination of education and experience.
Skills and Knowledge
- Language Skills
- Mathematical Skills
- Reasoning Ability
- Computer Skills
- Certificates, Licenses, Registrations
- Other Skills and Abilities
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.