Claims Service Representative 3 - SIU Investigator

This position is a Work from Home position. Candidates must live in the Southern California area.

This position handles moderate to higher complexity claims matters involving material damage, property and/or liability/casualty/injury lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include investigation, evaluation, and negotiation of moderate to higher complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices.

• Conduct phone and/or field investigations to determine liability and damages.

• May attend and participate in legal proceedings.

• Identify and obtain statements from insureds, claimants, and witnesses.

• Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements.

• Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.

• Negotiate within settlement authority with insureds and claimants to resolve first and third-party claims. Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, etc.

• Control expenses for areas of responsibility.  

• Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.

• Identify cross-sell opportunities based on members’ product needs and service requests.

• Enhance member relationship by diversifying use of products and services.

• Perform other duties and responsibilities as assigned or required.

Education:

• Four-year college degree or equivalent combination of education and experience required.

• Evidence of continuing education (i.e. industry designations) preferred.

Experience:

• Ability to service claims of low, moderate, and higher complexity as normally acquired through 5-15 years’ experience.

• Litigation, investigation or SIU experience required.

• Strong strategic/critical thinking ability required.

• Multi line business experience desirable.

• Advanced understanding of Vehicle repair procedures and issues or Building repair procedures and issues or Third-party liability issues.

• Moderate computer and line of business technical software skills required.

• Moderate knowledge of fault assessment and subrogation principles required.

• Moderate leadership competencies necessary.  

• Advanced organization and planning recognition skills required.

• Advanced oral and written communication skills required.

• Advanced interpersonal skills required.

Valid driver's license with a level of financial responsibility required by the club and an acceptable motor vehicle record required for field positions.