Claim Representative, Accident Benefits

3 weeks ago

Oakville, Canada The Travelers Companies, Inc. Full time

- Who Are We?


- Solid reputation, passionate people and endless opportunities. That’s Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.

- Job Category
Claim

- Target Openings
3


- What Is the Opportunity?


- 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 role is responsible for handling 1st party Personal Insurance and Business Insurance AB claims. The AB role handles a wide variety of causes of loss. In addition, the role applies policy, legislation and company guidelines to all claims to manage loss costs and customer relations. Occasionally the AB role handles claims with complexities related to unique coverage and/or damage issues. This position does not manage staff.

What Will You Do?
- Handling 1st party PI and BI AB claims of low to moderate severity and complexity as assigned
- Making contact with insured 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
- Investigative Duties:

- Investigating and evaluating all relevant facts to determine coverage, damages and liability of first-party AB claims under a variety of policies
- Conducting prompt investigation of coverage and liability
- Documenting claims files in accordance with Best Practices
- Claim Practices and Field Support:

- 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 AB 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
- Business Processes:

- 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
- 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 to 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 fol

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