Senior BI Litigation Representative

National General Insurance - Houston, TX3.1

30+ days agoFull-time
Primary Purpose:
Examine claims data, investigate the facts, determine liability and adjust claims of a serious and complex nature within the limit of authority. Casualty and material damage claims with substantial damage and/or exposure may be involved. Claims involved normally require detailed analysis and research to resolve coverage and/or damage issues. Serve as mentor for others and assists with projects, and expected to work independently with minimal supervision as the manager relies upon this role in his/her absence.

Essential Duties and Responsibilities:
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement
Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; may inspect damaged property, and review loss reserves and adjust or opens hidden exposures as necessary
Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submits to manager for approval
Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
Determine subrogation or fraud potential and refer to Unit when potential exists or handles to conclusion
If handling PIP may participate in investigations of medical providers and attend EUOs
May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files
May assist in training and development of Claim Representatives or serve as a mentor for claims representatives
May assist with file reviews and audits
Is proficient and able to train others in using all systems and technology used within the company
May be required to make personal appearances on behalf of the company when requested
May also assist manager with preparing reports and completing projects
Identify customer needs and work to meet those needs using appropriate customer service skills

Required Skills and Competencies:
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience
Successfully completes Claim Representative trainee program
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Obtain/Maintain appropriate licensing or educational requirements
Demonstrate the capability of consistently handling aggregate file exposures of at least $15,000
Demonstrate proficiency in file audits to agreed standard of efficient claims quality
Has thorough knowledge of claims policies and procedures in resolving claims and/or providing technical direction to claims representatives
Often a source of directions for others on claim policies and procedures
Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine action plan, and rarely requires assistance on complex claims
Demonstrate thorough understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, and other potential exposures
If handling material damage, can accurately handle any type of material damages claim within limit of authority
When handling injury claims, can review, evaluate and negotiate any type of injury claim, and demonstrate ability to handle more serious injuries
When handling litigation, demonstrates ability to handle more complex litigation in accordance with company guidelines, recognize legal issues, and utilize ADR when appropriate
Demonstrate an understanding of insurance law as it relates to claims
Demonstrate the ability to find answers to more complex issues with insurance law
Demonstrate a working understanding of the insurance industry and organizational relationships of the company
High degree of initiative, mature judgment, and discretion
Ability to resolve conflicts and empathize with customers is critical
Strong negotiation skills
Demonstrate professional oral and written communication skills
Organization, customer service, and time management skills are critical for this position
Demonstrate an understanding of insurance law as it relates to claims
Demonstrate the ability to find answers to more complex issues with insurance law and may be a source of direction / assistance for other representatives
Demonstrates effective leadership and mentoring skills

Desired Skills:
Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing

National General Holdings Corp. is an Equal Opportunity (EO) employer - Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

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