Under close supervision, this position is responsible for investigating and evaluating, primarily low to moderate complexity claims, to determine coverage available to policyholders and claimants.
This role is responsible for handling 1st and 3rd party Personal Insurance and Business Insurance APD claims. The APD role handles a wide variety of causes of loss.
In addition, the role applies policy, legislation and company guidelines to all claims to manage loss costs and customer relations.
Occasionally the APD role handles claims with complexities related to unique coverage and / or damage issues. This position does not manage staff.
Primary Job Duties & Responsibilities
Handling 1st and 3rd party PI and BI APD claims of low to moderate severity and complexity as assigned : Making contact with insured within Best Practice guidelines.
Returning all phone calls and emails within Best Practice guidelines. Providing clear explanation of claims process and coverage to all customers.
Acting as primary contact for customer and as intermediary between customer and other parties. Participating in extended hours duties as required.
Advises underwriting of any information gathered which may affect risk assessment. Investigating and evaluating all relevant facts to determine coverage, damages and liability of first-party APD claims under a variety of policies.
Conducting prompt investigation of coverage and liability. Documenting claims files in accordance with Best Practices. Managing pending and settles claims within company averages based on type of claim, complexity of claim and geographical area.
Establishing accurate scope of damages and utilize as a basis for written estimates and / or computer assisted estimates : Working diary system to be proactive on files.
Reviewing and analyzing policy conditions, provisions, exclusions and endorsements pertinent to a variety of APD losses.
Reviewing amounts on all invoices and all documentation supporting payments. Maintaining diary follow up on all files to ensure prompt disposition.
Ensuring that all claims files and company information are kept confidential. Identifying and following up on all salvage and subrogation opportunities promptly.
Completing a level of investigation that is commensurate with the financial exposure on each loss handled. Managing files in accordance with established Best Practices.
Obtaining and analyzing leases, contracts, by-laws and other relevant documents which may have an impact on the adjustment of losses.
Establishing timely and accurate claim and expense reserves. Posts all reserves in system within Best Practice guidelines and updates system promptly as new information received : Posting all reserves in system within file standards guidelines and updates system promptly as new information received.
Determining appropriate settlement amount based on independent judgment, computer assisted estimates, estimation of actual cash value and replacement value, appraisals, application of applicable limits and deductibles.
Explaining payment amounts to all customers by email or letter. Referring all files above settlement authority, with recommendations for resolution, to Unit Manager and follows up through closure.
Negotiating and conveying claim settlements within authority limits to insureds. Writing denial letters, Reservation of Rights and other complex correspondence to insureds.
Controlling damages through proper usage of cost containment tools. Meeting all quality standards and expectations per file standard guidelines.
A minimum of one year previous work experience. Experience utilizing computer technology; such as Microsoft Office, e-mail, Web-enabled applications, and database software required.
Ability to accurately compute a variety of numerical calculations required. Licensing Required : In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.
Must secure and maintain company credit card if required.
Education, Work Experience & Knowledge
University Degree / College Diploma or equivalent business experience. Enrolment in the CIP program is an asset.
Job Specific & Technical Skills & Competencies
High proficiency with Windows-based programs including spreadsheet and word-processing applications. Strong verbal and written communications skills.
Ability to deal with people and communicate effectively by telephone. Ability to understand and apply policies and procedures.
Proficiency in typing. Excellent organizational skills with ability to work independently. Solid analytical and decision making skills.
Adjusters license as required, based on business needs. Customer service orientation; empathy. Demonstrated ownership attitude and customer centric response to all assigned tasks.
Math skills. Excellent negotiation skills. Hardware and software skills to utilize and leverage claim and estimating technology.
Licensing or Certificates
In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.
Generally, License(s) are required to be obtained within three months of starting the job.