<p>Summary:</p> <p>Under minimal to no supervision, reviews, investigates, evaluates, negotiates and resolves a variety of multi-line casualty claims including but not limited to disputed liability, personal injury, coverage disputes, and contract based losses, and specialty claims of a complex nature. Independently handles all aspects of assigned claim inventory in line with department standards, procedures, and appropriate claims practices.</p> <p>Duties:</p> <ul> <li> <p>Claim Intake and Initial Processing</p> </li><li> <p>Receives claim loss information from agencies, insured, and claimants or other involved parties via telephone, facsimile, mail, or computer; and establish a claim on the appropriate computer claim handling system.</p> </li><li> <p>Reviews limited assignments, as well as assigned claims for applicable coverage, liability, and exposures.</p> </li><li> <p>Posesses working knowledge of all lines of business written by the company, including, but not limited to auto, homeowners, dwelling fire, commercial general liability, and umbrella.</p> </li><li> <p>Makes initial contact with insured and any other involved parties within the specified time frame, as outlined within department procedure.</p> </li><li> <p>Determines/confirms facts of loss, cause of loss, the identification of parties involved, and the existence of/extent of injuries and/or damages involved.</p> </li><li> <p>Reviews applicable policy forms/coverage documents, determine and explain available coverage and benefits, and address/resolve conflicts.</p> </li><li> <p>Establishes appropriate initial reserves on the computer claims-handling system within the specified time frame outlined within department procedures.</p> </li><li> <p>Investigates and handles losses in an appropriate, adequate, and thorough manner.</p> </li><li> <p>Obtains written or recorded statements as needed.</p> </li><li> <p>Investigation and Documentation</p> </li><li> <p>Ensures that damages, scenes, etc. are inspected, photographed, diagramed, and properly documented. Secures and protects evidence, as required.</p> </li><li> <p>Obtains other documents and records, such as police and fire reports, contracts and legal agreements, medical bills and reports, etc.</p> </li><li> <p>Prepares and submits any required data and reports (such as injury index, Medicare), per department procedure</p> </li><li> <p>Determines liability based upon the facts and a working knowledge of the applicable Hawaii Revised Statutes and any other applicable laws.</p> </li><li> <p>Stays abreast of statute changes, case law decisions, as well as policy and coverage changes.</p> </li><li> <p>Evaluates damages and/or injuries considering applicable coverage, liability determination, and any other pertinent information developed within the investigation.</p> </li><li> <p>Negotiates settlements within the authority granted.</p> </li><li> <p>Recognizes subrogation opportunity and complete the appropriate investigation in support of the pursuit of financial recovery on the claim. Assist the Subrogation unit, or complete arbitration filings as required.</p> </li><li> <p>Recognizes third party liability and contribution, and the handling and resolve of loss accordingly.</p> </li><li> <p>Initiates deductible recoveries with an insured per policy/coverage.</p> </li><li> <p>Communication and Reporting</p> </li><li> <p>Reviews questionable claims and all coverage issues with department management.</p> </li><li> <p>Communicates loss status to insured, claimant, or an attorney, as required by law or by department procedure.</p> </li><li> <p>Accurately processes financial transactions upon the applicable computer claims handling system, to include establishing or adjusting reserves and making payments within granted authority.</p> </li><li> <p>Prepares and submits requests and required reports, for increased financial authority, as required by department procedure.</p> </li><li> <p>Maintains a diary on all active claims with diary date established and addressed in line with department procedure.</p> </li><li> <p>Enters timely, clear, concise notes within the applicable computer claims handling system(s) related to investigation, handling, assessments, evaluations, and negotiations and settlements on all assigned claims.</p> </li><li> <p>Manages and directs any/all outside vendors (such as independent adjusters, contractors, repair shops, experts, or attorneys).</p> </li><li> <p>Litigation and Legal Compliance</p> </li><li> <p>Handles claims and/or litigation cases, as assigned.</p> </li><li> <p>Follows prescribed litigation guidelines and procedures, including reporting requirements and legal fee review program.</p> </li><li> <p>Attends and participates in mediations, arbitrations, settlement conferences as directed.</p> </li><li> <p>Travels to the neighbor islands as required for inspections and client visits.</p> </li><li> <p>Informs Claim Supervisor of any/all oral or written complaints, and any coverage dispute.</p> </li><li> <p>Prepares and timely submits required reports as may be required by procedure, department management, the company, or a vendor of the company.</p> </li></ul> <p>Education/Experience:</p> <ul> <li>High school diploma or general education degree (GED); and 3 to 5 years multi-line claims and litigation management experience as a Claim Service Representative required. </li><li>College degree with credits in insurance related subjects preferred. </li><li>Equivalent combination of education and job-related experience will be considered. </li><li>Continuing education in insurance and job-related issues and subjects required </li></ul> <p>Certificates, Licenses, Registrations:</p> <ul> <li>Valid Hawaii Driver license and use of own vehicle required. </li><li>State of Hawaii general adjusting license preferred. </li></ul> <p>An Equal Opportunity Employer Committed to an Inclusive Workplace.</p>