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 position is responsible for handling 1st party Personal Insurance and Business Insurance property claims. The largest segment of inside claims involves personal property and business personal property related to crime or disappearance causes of loss.
In addition, a wide variety of other causes of loss may be handled. Applying policy, legislation and company guidelines to all claims to manage loss costs and customer relations.
Claims will also involve low severity building damage losses. Occasionally handling claims with additional complexities related to unique coverage and / or damage issues.
This position does not manage staff.
Primary Job Duties & Responsibilities
Handling 1st party PI and BI Property 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 property claims under a variety of policies.
Conducting prompt investigation of coverage and liability.
Documenting claims files in accordance with claim property 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 for building and contents losses 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 property 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.
Researching company experience / available case law to substantiate quantum, coverage and liability for casualty claims.
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 building and / or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, 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.
Managing file inventory to ensure timely resolution of cases.
Handling files in compliance with provincial regulations, where applicable.
Providing excellent customer service to meet the needs of the insured, broker and all other internal and external customers.
Identifying and referring claims with Major Case Unit exposure to the Unit Manager.
Identifying and referring claims that may have valued added by an outside field inspection.
Identifying and referring tasks to Travelers of Canada (Outside Adjuster), wherever complex claims are identified for immediate transfer to the appropriate level of Adjuster for special handling.
Determining cases that may have fraud potential and to refer claims to Travelers Investigative Services.
Identifying potential for subrogation and refer appropriate claims to the Subro Unit.
Virtually handling inside claims from across the country; manage periods of increased claim volume.
Occasional travel for Catastrophe Duty, including other offices and provinces may be required.
Performing any other duties as required.
Ensuring that all claims files and company information are kept confidential. Identifying and following up on all salvage and subrogation opportunities promptly.
Education, Work Experience & Knowledge
University Degree / College Diploma or equivalent business experience preferred.
Basic knowledge of construction preferred Work experience providing customer service preferred.
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.
Excellent negotiation skills.
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.