Telephone Claims Representative

: Job Responsibilities:

This position is responsible for providing prompt and efficient claims service.

MAJOR RESPONSIBILITIES AND AUTHORITY

Handle those claims that meet the “Telephone Claims” criteria from start to finish in a timely, fair, and reasonable manner, within the limits of the policies.

Answer all calls, email, and voicemail promptly.

Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases.

Open, review, and recommend proper reserves on all claim files assigned, and ascertain the proper amount of damages on all assigned claims in a prompt and efficient manner.

Complete loss notices on the Electronic Loss Notice system for claims called into the office, when necessary.

Investigate and submit coverage questions and Agents' error and omission claims.

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

Maintain current and accurate knowledge regarding trends in claim handling and innovative settlement techniques.

Confirm status of policy and coverage.

Pay and process claims within designated authority.

Assign claims to other TCRs or to field claims representatives, according to company procedures.

Complete and forward claims department reports to underwriting, as required.

Refer claims for subrogation as appropriate.

Report suspicious claims to SIU.

Direct potential misrepresentation on the application (MOTA) to Telephone Claims Supervisor.

Comply with the Certified Fleet Operator requirements of the Company Driving and Safety Policy.

Assist in other locations as needed due to storms.

Assist when needed in various capacities due to vacation, storms, and overloads.

Report to assigned lead in event of an absence or vacation.

Refer diminished value claims to Telephone Claims Supervisor.

Achieve company standards, follow set claims procedures, and adhere to Claims department standards.

Immediately advise Telephone Claims Supervisor or State Physical Damage Manager of all lawsuits and time demands.

Other duties as assigned.

Job Qualifications:

Four-year degree from an accredited college or university.

Acceptable credit rating.

All Lines Adjuster license from the Texas Department of Insurance, maintained according to the licensing requirements set forth by the state of Texas; or possess ability to obtain such license in a reasonable timeframe.

Strong problem-solving abilities.

Ability and willingness to learn and extend skills.

Strong oral and written communication skills.

Proficiency in Microsoft Office software required.

Willing to travel as required.

Valid Texas driver's license and driving record at the time of hire which would not place the employee on probation or disqualify the employee from Certified Fleet Operator status under the Company Driving and Safety Policy.

Other Job Information (if applicable):

Occasional long, irregular hours.

Occasional travel by auto or other public transportation.

Work to be conducted in office environment owned or leased by company.

REVISED January 2025