Job Description
Job Description
The Senior Casualty Claim Representative will be responsible for the handling of First- and Third-Party Bodily Injury and Physical Damage claims in a Personal Lines /Commercial environment for the Plymouth Rock Operation. The candidate must have the skills listed below and be able to perform the following duties
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RESPONSIBILITIES
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\n - 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.
\n - Analyze, review and interpret policies to assess coverage and liability. Provide advice to Excess and Primary coverage issues.
\n - Willing to conduct investigations, interviews with insureds, witnesses and claimants while maintaining a pending of represented claimant cases.
\n - 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.
\n - 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.
\n - 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.
\n - Have advanced skills in coverage, investigation, litigation/ legal issues, negotiations, evaluations, medical terminology, and subrogation. Handle more complex claims to include coverage issues, UM/UIM, etc.. Also, must have prior litigation handling.
\n - Recognize and investigate subrogation potential.
\n - Negotiate both 1st and 3rd party claims directly with injured parties or their attorneys.
\n - Exercises proper judgment and decision making to analyze exposure, determine the proper course of action and make recommendations for final resolution.
\n - Attend litigation proceedings to either represent the company or participate in arbitrations/depositions/settlement conferences/ mediations/ trials.
\n - Attend all internal and external training events as required.
\n - Participate in proactive team activities to achieve departmental and company objectives. May be asked to participate in special projects, committees or assignments from management.
\n - Possess strong organizational skills, able to demonstrate time management, has the ability to prioritize multiple tasks/duties, and be proficient in the utilization of all claims systems, Excel, Word and social media search engines.
\n - Have strong communication skills both verbal and written. Provide strong customer service. Prepare case summary for significant reserve increase and/or trial alerts. Participate in roundtables.
\n - Capable of working independently without close supervision, high level of self motivation, effectively manage workload while maintaining diary and focus on claims quality.
\n - Ability to handle multiple responsibilities and be adept at conflict resolution while working in a team environment. Work well under pressure. Able to think strategically, solve problems, set priorities, make the necessary decisions to resolve complex/regular issues/claims.
\n - Possess knowledge of and adherence to State(s) laws and regulatory claim handling guidelines and statutory regulations.
\n - Adhere to departmental internal control requirements. Comply with Plymouth Rock’s standards, best practices and ethical guidelines, adhere to Plymouth Rock’s culture
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QUALIFICATIONS
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\n - A bachelor's degree (B.A.) from an accredited four year college or university.
\n - 3 - 5 years’ experience handling liability and/or Personal Injury Protection claims.
\n - 4+ years of experience handling bodily injury or casualty claims.
\n - Some litigation experience and knowledge of the New Jersey court system is preferred.
\n - Knowledge of PA, CT or NY claims handling would be beneficial.
\n - Currently holds and/or can readily obtain an out of State License(s) (i.e. - CT, Delaware, Florida, etc.) is preferred
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The pay range for this position is $81,000 to $105,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
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PERKS & BENEFITS
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\n - 4 weeks accrued paid time off + 9 paid national holidays per year
\n - Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
\n - Annual 401(k) Employer Contribution
\n - Free onsite gym at our Woodbridge Location
\n - Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
\n - Robust health and wellness program and fitness reimbursements
\n - Various Paid Family leave options including Paid Parental Leave
\n - Tuition Reimbursement
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