Nationwide Clms Spec I, Cas Bodily Injry (Bodily Injury Claims Specialist - Lone Tree, CO) in Lone Tree, Colorado
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Number 54 on the Fortune Magazine 100 Best Places to Work.
JOB SUMMARY: Investigates and effectively resolves bodily injury personal lines liability claims via telephone, internet or email. Promotes and provides "On Your Side" customer service. In an office environment, via phone, e-mail or internet, specializes in complex casualty claims. Adjusts serious exposure claims requiring investigation, liability evaluation and negotiation. Oversees control and supervision of suit files to conclusion and oversees the activities of defense counsel. Expedites settlement and control of average loss cost and litigation expense in compliance with best claims practices
RELATIONSHIP: Reports to Claims Manager
DIRECT REPORTS: None
Utilizes various methods of settlement in those cases where warranted; assigns cases to outside vendors as warranted. Appropriate use of structure settlement on all applicable cases.
Promptly and effectively handles to conclusion all assigned claims with moderate direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Initiates and conducts follow-ups via proficient use of claims systems and related business systems
Determines proper policy coverages, and where necessary, investigates, evaluates, negotiates and equitably settles all assigned liability/bodily injury claims cases in accordance with company policies and procedures at values commensurate with damages sustained.
Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. In accordance with Corporate Reserving Guidelines. Adheres to file conferencing notification and authority procedures.
Partners with SIU and Subrogation to identify fraud and subrogation opportunities.
Maintains and develops current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training sessions.
Submits severe incident reports, reinsurance reports and other information to claims management as needed.
Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty)
Utilizes all internal resources (special investigation, medical, claim legal, etc.) when appropriate in the handling and resolution of claims.
Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
Adheres to high standards of professional conduct while providing delivery of superior claims service.
Initiates and conducts follow-ups via proficient use of claims systems and related business systems.
Other duties as assigned.
Education: Undergraduate degree or equivalent experience preferred.
Licenses/Designations: State licensing where required. Successful completion of required claims certification schools/classes.
Experience: One to three years of customer service and/or claims processing/handling experience preferred. Bodily injury claims experience preferred.
Knowledge: General knowledge of insurance theory and practices, insurance contracts and their application. General knowledge of causality claims best practices, medical terminology and liability analysis preferred. Proven knowledge of insurance contracts, medical terminology and the legal aspects of court procedures affecting legal liability for all lines of insurance. Knowledge of claims systems.
Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Analytical skills necessary to make decisions/resolve conflicts such as application of coverage's to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions, and direct repaid shop claims management. Ability to work in a fast paced and team based environment. Organizational skills to effectively prioritize and manage increased workloads. Demonstrated proficiency of written/verbal communication skills for contact and/or negotiations with policyholders, claimants, repair persons, attorneys, agents, and the public in general. Ability to efficiently operate personal computer and software for claims-related and other business applications.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.
Working Conditions: Normal office environment. May require ability to sit and operate telephone and personal computer for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple on-site responsibilities and/or for extended periods of time. Extended and/or non-standard hours as required.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Job Evaluation Activity: Edited 5/2/11 JTG
Additional Job Description
Job ID: 55056