Claims Investigator

Description

Position Summary;

 This position is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster.  This will include researching and investigating EZ Claim Total Loss, GAP, CPI and others as assigned.  This position will involve the initial processing and investigation of 20-40 claims per day.  This position ensures that all claim documentation is thoroughly reviewed and assessed for coverage application.  This position will also review database information found in systems such as Unitrac, insurance company websites, Lexis Nexis, ISO, and other automobile databases to investigate the applicability of insurance coverage to certain claim types prior to the assignment to a Claims Adjuster or Analyst.

 The key responsibilities of this job are both administrative and investigative.  The ability to understand and apply the basic coverage aspects of insurance policies is required along with securing all required documentation for claim calculation/adjudication.

 Associates in this position must process and investigate a high volume of incoming claim assignments, evaluate coverage through an investigative set of online tools and databases, as well as insurance records within our insurance tracking system.  This is a high production, detail-oriented, investigative position that requires strong analytical abilities.

• Review all required claim documentation including security agreements, condition reports, loan histories, valuation databases, statements by pertinent parties, ISO, Lexis Nexis and other public and private sources of insurance verification, and accident report providers to match the  damage on a unit of collateral to a corresponding insurance policy;
• Determine the appropriate application of coverage and damage to identify those claims with the highest amount of recovery potential for EZ Claim Total Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection;
• Adjudicate claims within the guidelines of the appropriate carrier on GAP and CPI.  Then, refer to licensed adjuster for final claim calculation and release
• Ability to use and understand programs associated with auto valuation including CCC, Auto Appraisal information (AUDATEX), ISO, NADA, Kelley Blue Book, and other adjusting tools;
• Meet and exceed all established recovery and claim service standards and benchmarks for a Claims Investigator.
• Promptly and effectively respond to both carrier and lender correspondence and claim inquiries in a professional manner.
• Answer incoming calls to the claims department and handle or direct as necessary;
• Complete other special projects and duties as assigned
• Obtain adjuster licenses as needed

• Associate college degree required except in the following circumstances:
• Internal insurance/recovery claim experience as a Claim Processor or Claim Specialist with a minimum of 9 months to 2 years of internal experience
• A HS degree with a minimum of 1-3 years of insurance claim experience
• Property and Casualty insurance experience of 1-3 years highly preferred;
• Preference given to those with Claim Processor or Claim Specialist experience;
• Excellent telephone, written, and verbal communication skills required;
• Strong decision making and organizational skills required;
• Strong analytical and investigative skills required, along with the ability to explain insurance policy language;
• Strong drive for results with a proven track record of achievement as results are tied directly to recoverable claim dollars;
• Ability to evaluate potential claims which would include using intellect to interpret policy provisions and apply the policy language to individual claim losses;
• Ability to discern important file facts and document all pertinent issues associated with individual claim files with some level of supervision;
• Ability to determine coverage and damages owed on claims by assessing the merits of individual claim files and applying the facts uncovered through the investigation and evaluation process;
• Ability to interpret and comply with all regulatory mandates within individual jurisdictions, including state adjusting licensing requirements.
• Ability to investigate the potential for recovery by examining the evidence of the loss and confirming the existence of insurance or other responsible parties;
• Ability to compute in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent, and to draw and interpret statistical material
• Ability to solve practical problems and deal with a variety of concrete variables in situations where limited standardizations exist;
• Mastery knowledge of computer databases and investigative sites with the ability to use internal e-mail system and the ability to type at least 45 WPM;
• Strong attention to detail
• Ability to work independently in a fast-paced environment production environment