Clms Spec II, Cas Bodily Injry

Company Name:
JOB SUMMARY: Investigates and effectively resolves complex bodily injury personal lines liability claims via telephone, internet or email.- Responsible for the disposition of claims in accordance with prescribed authority and according to best claims practices. Promotes and provides ""On Your Side"" customer service. Investigates and effectively resolves personal lines liability claims via telephone.- Responsible for the disposition of claims in accordance with prescribed authority and according to best claims practices.
RELATIONSHIP: Reports to Claims Manager
1. Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
2. Utilizes various methods of settlement in those cases where warranted; assigns cases to outside vendors as warranted.- Appropriate use of structure settlement on all applicable cases.
3. Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary.- In accordance with Corporate Reserving Guidelines.- Adheres to file conferencing notification and authority procedures.
4. Maintains current knowledge of: all insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications.- This may require attendance at various seminars or training sessions.
5. Submits severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting.
6. Partners with SIU and Subrogation to identify fraud and subrogation opportunities.
7. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
8. Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management.
9. Other duties as assigned.
Education: Undergraduate degree or equivalent experience preferred.- Postgraduate studies in medical field or law desirable.
Licenses/Designations: State licensing where required. Successful completion of required claims certification courses/schools.
Experience: Three to Five years claims handling experience including experience handling complex bodily injury claims.-
Knowledge: Proven knowledge of insurance theory and practices, insurance contracts and their application. Advanced knowledge of causality claims best practices, medical terminology and liability analysis preferred. Proven knowledge of insurance contracts, medical terminology and the legal aspects of court procedures affecting legal liability for all lines of insurance.- Excellent customer focus and proven ability to proactively meet customer needs. Proven knowledge of insurance contracts, medical terminology, workers compensation,- and the legal aspects of court procedures affecting legal liability for all lines of insurance.- Knowledge of claims systems. Proven analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to establish repair requirements and cost estimates for extensive losses and serves as a subject matter expert on respective claims projects. Proven organizational skills to effectively prioritize increased and more complex workloads.Demonstrates strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants,attorneys, agents, and general public. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates.
Skills/Competencies:- Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Analytical skills used to make independent decisions and resolve conflict; coordinate the handling of cases involving serious and sometimes complex liability issues.- Exceptional oral and written communication skills for contract and negotiation with all policyholders, claimants, attorneys, physicians, agents and the general public.- Ability to successfully negotiate casualty claims including the ability to interpret medial reports and legal reports.- Organizational skills to effectively establish work priorities in accordance with best claims practices.- Ability to operate a personal computer with proficient use of claims and business software.
Values:- Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by:- Business Unit Executive and Human Resources.
Working Conditions: Normal office environment. May require ability to sit and use telephone and personal computer for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT site with multiple on-site responsibilities and/or for extended periods of time. Extended and/or non-standard hours as required.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job.- Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Job Evaluation Activity: Edited 5/2/11 JTG

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