Corporate - Sr. Claims Representative

2 months ago | Lithonia, GA

Position Overview: ***This is not a REMOTE position***

To review and discuss new as well as existing claim files with the Claims Manager to determine clear liability and ensure that payments and settlements have been made by company practices and procedures. Report overpayments, underpayments, and other irregularities as required. Take in and set up all claims and enter them into the company database. Prepare and send subrogation packets to proper claimants/insurance carriers where needed. Confer with the Claims Manager on claim files with potential litigation.

 

Responsibilities:

DUTIES REGARDING ACCIDENT CLAIMS INCLUDE BUT ARE NOT LIMITED TO:

1. Answer and direct incoming calls to the claims department.

2. Phone calls regarding accidents - take all necessary information, determine the severity of an accident, and call in an outside TPA for assistance where needed.

3. Discuss and confirm with Company Drivers (CVOs) and Owner Operators (O/O’s) any injuries to themselves and/or other parties involved in an accident and get as much information as possible. Ask the driver if the other party would be willing to communicate with the claims department on the phone.

4. Discuss and confirm with CVOs and/or O/O’s on what types of photos to get while they’re on-scene and confirm with them to complete this safely. Also, advise the drivers that if any conflict arises from the other party(ies) involved to avoid any possibility of any further incident while on-scene and to stay in their vehicle if necessary.

5. Enter claim information into the company database using concise yet sufficient details for file documentation.

6. Set up DOT drug screens/BAT testing through CMS for drivers when required.

7. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

8. Pay and process claims within the designated authority level.

9. Conduct detailed bill and estimate reviews to ensure expense control as well as accuracy and fairness within industry standards.

10. Communicate with the Claims Manager and Claims Staff as needed to obtain information necessary for processing claims.

11. Contact claimants, drivers (CVOs or O/O’s), TPA adjusters, work comp adjusters, or employers to obtain additional information as needed.

12. Examine claims investigated by assigned TPA’s to ensure accurate descriptions of the loss scene, investigation thereon, and assignments are given are reflected accurately.

13. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

14. Observe, receive and otherwise obtain information from all relevant sources where needed including police reports, claimant insurance information, etc.

15. Provide information to supervisors, co-workers, and all necessary parties via phone call, written communication form (e-mail), or in person. Keep all necessary personnel updated per company policy/procedures.

16. Analyze all information and evaluate possible results to choose from and decide which would be the best solution.

17. Send subrogation demands/packets accordingly to the liable party with continuous follow-up until the claims are settled in full and closed.

18. Perform day-to-day tasks such as maintaining information files and processing necessary paperwork.

 

DUTIES REGARDING TRAILER CLAIMS INCLUDE BUT ARE NOT LIMITED TO:

1. Answer and direct incoming calls to the claims department.

2. Phone calls regarding trailer claims - take all necessary information, determine the severity of the damages involved and call in an outside TPA for assistance where needed.

3. Discuss and confirm with CVOs and/or O/O’s on what types of photos to get while they’re on-scene and confirm with them to complete this safely. Also, advise the drivers that if any conflict arises from the other party(ies) involved to avoid any possibility of any further incident while on-scene and to stay in their vehicle if necessary.

4. Enter claim information into the company database using concise yet sufficient details for file documentation.

5. Research all known sources to determine whether or not the location of the trailer uses a spotting service to move trailers around the yard. If so, find out the contact name/number to contact them to see if they are aware of the damages involved and if they will be accepting liability for those damages.

6. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

7. Send subrogation demands/packets accordingly to the liable party with continuous follow-up until the claims are settled in full and closed.

8. Pay and process claims within the designated authority level.

 

DUTIES REGARDING WORK COMP AND/OR OCCACC CLAIMS INCLUDE BUT ARE NOT LIMITED TO:

1. Answer and direct incoming calls to the claims department.

2. About Work Comp and/or OccAcc claims - take all necessary information and determine the severity of the injury(ies) involved. Once the injury(ies) is/are evaluated, determine if immediate medical attention is required or if in-house first aid will suffice.

3. Send all necessary medical forms, including the list of approved physicians for their area, to the office/terminal manager so the manager and/or employee can fill out the information. The office/terminal manager must send the completed forms back to the claims department for data entry into our database.

4. If immediate medical treatment is deemed necessary and the injury(ies) are severe enough or life-threatening, call 911 for emergency transport. If the injury(ies) are not life-threatening, have the employee taken to the nearest ER or Urgent Care facility via another employee or family member for treatment.

5. Interview the injured employee/driver and any witness(es) that are listed on the completed forms.

6. Observe and photo the accident/incident scene. Photos should include a good viewpoint of the area and the surroundings including any potential contributing factors that may have led to the injury (ie – cabinet drawers left open, wet floors/areas, uneven surfaces, etc.).

7. Enter claim information into the company database using concise yet sufficient details for file documentation.

8. File a Work Comp claim through Strategic either through their website or via phone call so they can assign a work comp adjuster. For Owner Operators, file an OccAcc claim through Great American Insurance via phone call so they can assign an adjuster.

9. Maintain constant follow-up with the employee, driver, and the Work Comp/OccAcc adjuster including physical therapy appointments, work status(es), etc. and document the file accordingly until file closure.

Environment and Physical Requirements:

The majority of time is progressive administrative duties directly related within the confines of an office setting. There will be travel by auto/plane as needed. Duties include administrative functions using the phone, computer, and communicating with people. Available to respond to emergency calls on nights/weekends as necessary. There will be minimal exposure to fumes, dust, and noise. This job will require occasional lifting of no more than 30 pounds. While performing these duties minimum bending of the waist, wrist, and shoulders is customary. Must be able to sit a minimum of 8 hours per day, perform keyboard operations a minimum of 6 hours per day, and must be able to stand and climb stairs as required.

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