UNKNOWN

ADAPTED_NOW

SUMMARY: To provide prompt, cost effective and efficient examination, investigation and settlement or denial of insurance claims up to the highest and most severe exposure with minimal supervision, by exercising independent decision- making skills and judgment. A concentration in property and casualty would be preferred; orTwo years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor-intensive customers.

SUMMARY: To provide prompt, cost effective and efficient examination, investigation and settlement or denial of insurance claims up to the highest and most severe exposure with minimal supervision, by exercising independent decision- making skills and judgment. RESPONSIBILITIES/TASKS: * Adjust a caseload of assigned files, including more severe and/or complex claims, in accordance with Ameritrust Group's policies and procedures. * Maintain an active diary on 100% of caseload files, with a current plan of action. * Adhere to assigned authority limits for reserving and payments (including settlements). * Exercise independent decision-making skills with minimal to moderate supervision and direction on claims assigned, using knowledge of local codes, laws, standards and case-law. * Verify coverage, investigate the loss by gathering all pertinent information, evaluate the claim, set reserves, negotiate settlements or deny payments where no coverage, liability or compensability exists. * Record statements, obtain documentation such as police reports, medical reports, appraisals, estimates, photographs, etc. to process claims in accordance with Company Best Practices. * Evaluate loss, assess reserve and settlement value where applicable and settle cases with claimants, insureds and attorneys autonomously. * Decide on denial of coverage, liability or compensability. * Identify and thoroughly investigate all possible recovery and subrogation opportunities revealed in the claims handled. * File all state and/or federal forms, filings and reports in accordance with statutory Guidelines. * Return all telephone calls within one (1) business day, when possible. All messages are to be returned by the end of the same business day in which the call was received. Reports all service complaints to Claims Supervisor or Claims Manager immediately upon receipt. * Maintain personal compliance with all continuing education requirements as mandated by statute or by office policy. * Manually or electronically document files in a timely fashion with all appropriate information, in a legally accepted, factual manner. * Understand coverage issues, including more severe and/or complex claims, with good knowledge of exclusions, endorsements on standard ISO forms. * Provide training to other Claims personnel when required by Claim Management. * Recognize settlement or exposure value and be able to use tools to assist in settling cases, such as structured settlements, arbitration, mediation, etc. * Must adhere to the company code of ethics. * Professional and timely communication with all internal and external vendors. * Performs related duties as assigned * Attendance 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 * 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 * Seven years of progressively more responsible experience in a claims environment that provides the necessary skills, knowledge and abilities. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. A concentration in property and casualty would be preferred; orTwo years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor-intensive customers. QUALIFICATIONS * Ability and proficiency in the use of computers and company standard software specific to position. * Effective oral and written communication skills. * Effective customer service skills. * Ability to negotiate, build consensus and resolve conflict. * Ability to act as a representative

AF Group

Senior Claims Representative I - P&C

BCD Travel

FEED

May be required to perform work in the operations and/or service center teams along with Records Management or perform other activities in order to maintain or gain knowledge of current processes, procedures and systems relative to the areas of auditing for which they are responsible. Partner with training, management, and stakeholders to identify training needs based on quality assessment results Compiles, creates, prepares, and reviews for accuracy, information and reports as requested or scheduled.

<h5>Job Description </h5>Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes. Primary focus includes, but is not limited to auditing the Document Specialists, Claims Document Analysts, Senior Document Analysts, Mail Clerks, and Inserter Operators. Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature. <h5>Primary Responsibilities </h5><ul><li>Completes production and quality audits, reviewing completed work in comparison to established documented procedures to determine accuracy while providing support to staff as an acting SME. </li><li>Orients new employees to the departmental and unit procedures. </li><li>Collaborate with management and stakeholders to ensure understanding, alignment, and consistency in workflow performance. </li><li>Partner with training, management, and stakeholders to identify training needs based on quality assessment results Compiles, creates, prepares, and reviews for accuracy, information and reports as requested or scheduled. This includes analyzing trends and data, creating reports. </li><li>Reviews, investigates, and corrects documents routed to various error queues by multiple teams. </li><li>Provides individual and group support sessions and mentoring for all Records Management positions. </li><li>Participates in review of process changes with a clear focus on the potential impact to quality, accuracy, and results. </li><li>Provides feedback on comprehension and adoption of the training. May attend training sessions to understand changes to processes, regulations, and workflows. </li><li>Reviews, evaluates, and makes recommendations for process improvements. </li><li>Assists in the creation of departmental procedures and reference documents. </li><li>May be required to perform work in the operations and/or service center teams along with Records Management or perform other activities in order to maintain or gain knowledge of current processes, procedures and systems relative to the areas of auditing for which they are responsible. </li><li>Participates in projects as assigned. </li><li>Perform audit related investigation to troubleshoot error trends as it relates to business processes and/or training. May be responsible for researching operational audit best practices and making recommendations for improvement. </li><li>Maintains confidentiality of all information processed. </li></ul>This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required. Employment QualificationsA. Education Required: Associate degree in insurance, business or a related field. Combination of relevant education and work experience may be considered in lieu of a degree. B. Experience Required: Two (2) years experience with AF Group within the Claims, Business Development, Finance, Service Center, Records Management, or equivalent Enterprise experience that provides the necessary skills, knowledge and abilities. OR Three (3) or more years experience in an insurance organization which provides working knowledge in one or more of the following areas: records management, claims management, underwriting, finance or auditing. Skills/Knowledge/Abilities (SKA) Required<ul><li>Working knowledge of Workers Compensation claims, records management, and/or business development procedures, workflows, and rules for multiple states. </li><li>Excellent analytical skills to identify opportunities for improvement and recommend solutions. </li><li>Ability to comprehend consequences of various situations to make appropriate individuals aware of same for decision making. </li><li>Strong analytical and problem-solving skills. </li><li>Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information, and respond to questions as appropriate. </li><li>Ability to read, analyze and interpret policy documents, technical, legal, and financial information, and procedures manuals. </li><li>Excellent verbal and written communication skills. </li><li>Ability to manage multiple projects and meet necessary deadlines. </li><li>Basic knowledge of computers, spreadsheet software, and word processing and ability to enter accurately 50 WPM. </li><li>Ability to perform mathematical calculations. </li><li>Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format and edit as necessary. </li><li>Ability to maintain confidentiality. </li></ul>Additional Education, Experience, Skills, Knowledge and/or Abilities Preferred<ul><li>Ability to create surveys and survey criteria. </li><li>Completion of industry recognized quality or internal audit certification(s). </li><li>Advanced knowledge of industry best practices related to sound internal controls and audit techniques. </li><li>Ability to assist in the development and implementation of policies, practices, and procedures. </li><li>Bachelor's degree in business. </li><li>Insurance education coursework. </li><li>Certification or progress toward certification in courses focused on but not limited to Quality Auditor, Quality Manager, Six Sigma, or other quality designations is highly preferred and encouraged. </li></ul>Working ConditionsWork is performed in an office setting with no unusual hazards. Ability to lift up to 40 lbs. Minimal travel. 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.

Audit Quality Specialist - Records Management

Administrative Skills

Analysis Skills

Auditing

Best Practices

Business Development

Business Processes

Claims Management

Communication Skills

Computer Software

Data Analysis

Diversity

Employee Orientation

Finance

Financial Audit

Financial Procedures

Identify Issues

Insurance

Internal Audit

Legal

Lift/Move 40 Pounds

Mathematics

Mentoring

Multitasking

Needs Assessment

Operational Audit

Operations Management

Operations Research

Policy Analysis

Policy Development

Policy Implementation

Presentation/Verbal Skills

Problem Solving Skills

Procedure Development

Process Improvement

Project/Program Management

Proofreading

Quality Management

Records Management

Regulations

Reporting Skills

Six Sigma

Spreadsheets

Technical Writing

Time Management

Trend Analysis

Underwriting

Word Processing

Worker's Compensation

Writing Skills

IRecruitee

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Senior Claims Representative I - P&C AF Group

Audit Quality Specialist - Records Management AF Group

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