Claims Specialist II - North Carolina Joint Underwriting Association

POSITION TITLE: Claims Specialist II

DEPARTMENT: Claims

REPORTS TO: Claims Director or Designee

JOB SUMMARY: Within limited authority and under the guidance of the Claims Director or designee, adjusts and settles assigned claims by telephone. Authorizes settlement of all assigned claims within established limits. Is trained in Association claims handling policies and procedures and North Carolina Statutory {G.S. 58-63-15 (11)}Unfair Claims Settlement Practices. Performs other duties as may be required.

Claim Specialist II will have similar functions as a Claim Specialist I. However, will operate with less management involvement and encouraged to make appropriate decisions based on experience level. Additional responsibilities may include training and developing claims handling and/or project management skills.

DUTIES/RESPONSIBILITIES:

Candidates local to Raleigh are preferred. Remote candidates in NC, AL, PA, FL, GA, OH, OK, SC, TX, and VA may be considered.

· Learn all aspects of the Claims Administrative processing.

· Act as an in-office support capacity by handling physical checks and all claims mail.

· Learn to input new claims and assign adjusters and vendors to claim file based on workflow.

· Approve payment letters in Pitney and work various email inboxes and online portals.

· Support internal staff with requests made for file assistance.

· Learn coverages; learn to read and understand First Notice of Loss; learn the Associations’ Claims Department service and response standards.

· Learn about building systems, construction, and repair techniques. Learn costs of building construction components.

· Learn to make initial telephone contact with policyholder or claimant. Learn to examine, investigate, negotiate, and settle claims within established limits after securing proper documentation of the cause and extent of loss, applying policy provisions and exclusions, and documenting all file activity. Within assigned authority level, issue loss and expense payments and establish appropriate file and expense reserves on all assigned claims. Review diary and follow up as appropriate.

· Learn to write proper denial letter with an explanation to policyholder or claimant on claims for which no coverage is in force

· Investigate and evaluate recovery potential, and learn to perform or supervise the performance of all necessary recovery activities on those claims handled.

· Provide the knowledge and expertise in a specific subject(s) for a project.

· Support the definition of business processes and obtain additional expertise when necessary.

· Determine and support the implementation of a business policy, generally by providing the following the contents for the business rules that enforce the policy and the context in which the rules are applied.

· Resolve business issues relating to business rule execution. Collaborate with other departments. Present and defend decisions and recommendations to executives.

· Review the results of testing and simulation and write and execute test cases.

· Answer routine questions relative to area of responsibility.

· Participate in appropriate education as identified and assigned by Management.

OTHER DUTIES: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

EDUCATION AND EXPERIENCE: College degree preferred. Experience in liability and/or property insurance would also be considered, or a combination of post high school education and work experience. Intro to Insurance, Intro to Claims, INS. Course work also considered to offset experience. Construction estimating experience may be substituted for insurance experience. Existing agent or adjuster’s licenses desirable. An equivalent combination of education and experience may be substituted.

REQUIRED SKILLS AND ABILITIES:

• · Must qualify for North Carolina Adjuster's license

  · Typing skills equivalent to 40 wpm range.

  · Ability to clearly communicate information orally and in writing

  · Ability to work effectively and diplomatically with a wide variety of people including co-workers.

  · Ability to work with others in a team environment.

  · Ability to accept direction from superiors.

  · Ability to follow work rules and procedures

  · Ability to accept constructive criticism.

  · Ability to work flexible hours.

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

· Prolonged periods sitting at a desk and working at a computer

· Dexterity of hands and fingers to operate a computer keyboard, mouse, and other related devices

· Physically able to participate in training sessions, presentations, and meetings

· Travel to outside meetings required, possibly overnight

· May be required to travel to a temporary storm office