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SUMMARY:      

Provide prompt, cost effective and efficient examination, investigation and settlement or denial of insurance claims with moderate to severe exposure by exercising independent decision-making skills and judgement with minimal to moderate supervision. 

 RESPONSIBILITIES/TASKS: 

• Adjust a caseload of assigned files in accordance with company policies and procedures.
• Maintain an active diary on caseload.  Each file requires a plan of action.
• Adhere to assigned authority limits for reserving and payments (including settlements).
• The associate will be technically proficient in all aspects of claims handling, having gained the necessary knowledge and expertise in claim procedures, coverage, terminology, etc. from previous experience. Will have a strong knowledge of local codes, laws, standards and case-law.
• Receive claims assignments from the Claims Manager or Supervisor.  Determine coverage and the extent of liability or the compensability present with each claim. This requires the associate to verify coverage, investigate the loss by gathering all pertinent information, evaluate the claim, set reserves, negotiate settlements or deny payment where no coverage, liability or compensability exists. 
• Review statements and documentation such as police reports, medical reports, appraisals, estimates, photographs, etc. The associate may utilize the services of other Claims personnel or vendors when necessary to thoroughly investigate the facts.
• Assess reserve and settlement value where applicable. Settle cases with claimants, insureds and attorneys autonomously.  Determine denial of coverage, liability or compensability and to convey denials in a professional manner.
• Assure that the litigation is handled effectively and cost efficiently until a legal settlement has been reached or judgment has been awarded. Decisions regarding ongoing litigation, including decisions to appeal awards, are their responsibility.
• Responsible for identifying and thoroughly investigating all possible recovery and subrogation opportunities revealed in the claims. If the possibility for recovery or subrogation exists, the associate takes the necessary steps for recovery.
• All treating physician and attorney requests are to be responded to in a prompt and professional manner, within proper time frames as determined either by statute or office policy.
• All state and / or federal forms, filings and reports are to be filed in accordance with the statutory Guidelines.
• All medical bill and indemnity payments are to be made within statutory and / or office policy timeframes. Medical bills must be processed through applicable cost-containment procedures on a timely basis, as set by office guidelines or statutory allowances (Workers Compensation Adjusters only)
• Expected to keep abreast of all pertinent changes in the law and to maintain personal compliance with all continuing education requirements as mandated by statute or by office policy.
• The associate will work closely with Loss Control to return claimants to work and will notify Loss Control immediately if a policyholder is uncooperative in return-to-work efforts (Workers Compensation Representatives only).
• Expected to manually or electronically documents their files in a timely fashion with all appropriate information. This documentation must be complete and professional. The associate should be mindful of their duty to protect both the interest of our policyholder and of Meadowbrook Insurance Group by documenting in a legally accepted, factual manner at all times.
• Scopes losses and write estimates up to $100,000: (Property representatives only)
• Writes pro-forma balance sheets and income statements on Business interruption losses (Property / Casualty)
• Understands coverage issues and has good knowledge of exclusions, endorsements on standard ISO forms.
• Conducts preliminary investigations including, fire scenes, accident scenes, burglary losses.
• Negotiates settlements based upon analysis scope, estimate, coverage and income statements developed.
• May provide guidance to other Claims personnel and may participate in their training. The associate will perform other job-related duties requiring the same general knowledge, skill and degree of responsibility commensurate with the assigned position level.

ADDITIONAL RESPONSIBILITIES/TASKS: 

• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts. 
• Exercises independent judgment to settle cases prior to mediation or litigation. 
• Actively participates in agent/client relationship management.   
• Assists in mentoring team members. 

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required. 

EMPLOYMENT QUALIFICATIONS 

EDUCATION OR EQUIVALENT EXPERIENCE: 

Bachelor’s degree in a related field.  Relevant combination of education and experience may be considered in lieu of degree.  Continuous learning, as defined by the Company’s learning philosophy, is required.  Certification or progress toward certification is highly preferred and encouraged. 

 EXPERIENCE: 

Three years of experience in a property and casualty claims environment which provides the necessary skills, knowledge and abilities.  Experience handling claims in multiple jurisdictions preferred.  Bilingual skills preferred. 

One year of AF Group Claims Representative I experience that includes handling of difficult or complex claims. 

 SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Ability and proficiency in the use of computers and company standard software specific to position. 
• Knowledge of relevant laws and regulations, including jurisdictional laws. 
• Effective oral and written communication skills. 
• Effective customer service skills. 
• Ability to negotiate, build consensus and resolve conflict. 
• Ability to manage multiple priorities and meet established deadlines. 
• Attention to detail and analytical skills. 
• Ability to work independently as well as within a team. 

 ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Ability to make independent decisions. 
• Ability to solve complex problems.  

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. 

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

Pay Range - Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $54,200 and $78,550.

We are an Equal Opportunity Employer.  Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.

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