Entry-level claims representative responsible for investigating and evaluating minor-to-moderate claims, determining coverage, liability, and damages, communicating with customers, documenting investigations, managing claim statuses, and issuing authorized payments. The role includes training in claims handling, negotiations, settlements, diary management, and resolution procedures. Success requires strong customer service, organization, communication, analytical thinking, conflict resolution, and the ability to manage high claim volumes and frequent interruptions.
General Summary
The Associate AMD Claims Representative is an entry-level role that is designed for continuous career growth into the role of AMD Claim Representative. This position learns to investigate and evaluate AMD claims as well as resolves claims from a minor to moderate value. Formal training on claims handling, coverage investigations, negotiations, settlements, diary management, and overall claims resolution are part of the overall role.
Essential Functions
- Complies with company procedures and the applicable State Fair Claims Practices Acts.
- Reviews policies and claim forms, and manages all external communication with insureds, claimants, and other contacts associated with the claim to determine coverage, liability and damages.
- Maintains accurate claims and investigative reports.
- Provides optimal customer service during times of high claim volume, which can be frequent; must be able to manage high call, email, and text volume from various customers.
- Handles administrative responsibilities associated with the processing and payment of claims:
- records and updates status notes,
- documents the results of external information gathering,
- administers correspondence to customers regarding the status of their claims.
- Issues loss and expense payments within stated authority and comply with check security procedures.
- Works in a team environment to:
- promote and support the unit, department and organizational goals,
- communicate effectively,
- establish positive relationships with team members,
- work with colleagues effectively and professionally.
- Performs other duties as assigned.
Working Conditions
- Normal office working conditions.
- Sitting for extended periods of time.
- Eye strain and fatigue.
- Extended computer usage.
- Handling numerous phone and points of contact from customers daily
- Stress associated with high claims volume, upset customers, making difficult decisions and meeting deadlines.
QUALIFICATIONS
Skills and Abilities
- Must be proficient with operating a computer.
- Exceptional customer service skills.
- Experience working in a customer service environment where conflict resolution, time management, workload prioritization and follow-up are key priorities.
- Strong organizational and detail-oriented skills.
- Ability to focus and manage with frequent interruptions while dealing with various tasks.
- Ability to develop and maintain customer relationships.
- Strong verbal and written communication skills.
- Ability to manage conflict resolution.
- Strong analytical and critical thinking skills.
Education Requirements
- High School Graduate/GED
- College degree preferred or equivalent work experience.
SUPERVISION
Supervision Received
- Periodic supervision since most duties are repetitive and related with standard instruction and procedures as guides.
- Self-reliant with limited oversight.
- Unusual problems are referred frequently to the Claims Unit Manager with suggestions for correction.
Supervision
Exercised
- None
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