The Casualty Claim Representative will be responsible for the handling of First and Third Party Bodily Injury claims in a Personal Lines/Commercial environment for the Plymouth Rock Operation.
Essential Functions and Responsibilities
Initiate prompt contact of all insureds/claimants/witnesses on all new claim assignments to conduct thorough coverage and liability/injury investigations. These investigations might require the representatives take in depth recorded statements to investigate coverage and liability/injury claims.
Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues.
Conduct field investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented and unrepresented claimant cases.
Manage and direct outside vendors (Field/Counsel/Surveillance, etc.) to determine what investigation is necessary and give them direction to bring a claim to conclusion. Ensure only necessary work is completed.
Investigate cases timely so that reserves are established and maintained at proper levels. Revise reserves timely based on developments in the course of the claim.
Investigate the validity of bodily injury claims being presented by individual insureds/claimants or attorneys representing insureds/claimants. Be aware of certain "Red Flags" to identify potential fraudulent claims. Refer to SIU for investigation timely.
Handle complex claims to include coverage issues, UM/UIM, TNC, Commercial, Umbrella etc. Also, must have prior litigation handling.
Recognize and investigate subrogation potential.
Negotiate both 1st and 3rd party claims directly with injured parties and/or their attorneys.
Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution.
Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials.
Attend all internal and external training events as required.
Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management.
Utilize all claims systems, Excel, Word and social media search engines.
Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtable discussions.
Effectively manage workload while maintaining diary and focus on claims quality.
Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
Adhere to departmental internal control requirements. Comply with Plymouth Rock's standards, best practices and ethical guidelines, adhere to Plymouth Rock's culture.
Qualifications and Education
A bachelor's degree (B.A.) from an accredited four year college or university.
In-depth knowledge of litigation, arbitration and trial process, handle out of state claims, and/or Personal Injury Protection claims.
Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.). Professional designation such as IIA, AEI, Senior Claim Law Associate (SCLA) or Chartered Property Casualty Underwriting (CPCU) or be actively working towards a designation, preferred.
High level of self-motivation.
Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation.
Strong communication, organizational, customer service and time management skills.
Excellent problem solving skills.
Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
About the Company
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent".