MD Telephone Claims Trainee, I, II, Sr. in WFH-New York at National General Insurance

Date Posted: 9/20/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    WFH-New York
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    9/20/2021

Job Description

Primary Purpose:

Examines claims data, investigates the facts of loss, determines coverage and liability, and adjusts claims within limit of authority. Claims involved frequently require analysis and may require research to resolve coverage and/or damage issues. There is periodic review of ongoing activities and results of work.  There is more focused supervision on complex files (The CRII will handle complex files on a regular basis).

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 verifies/investigates coverage and documents all appropriate information
  • Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file
  • Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; and review loss reserves and adjust or open hidden exposures as necessary
  • Evaluate and adjust claims within limit of authority
  • 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; documents 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 lawsuits
  • Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level
  • Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
  • May assist in training of Claims Representatives
  • Perform other projects and assignments as directed
  • Is proficient in using all systems and technology used within the company
  • May be required to make personal appearances on behalf of the company when requested
  • Identify customer needs and works to meet those needs using appropriate customer service skills

Primary Purpose:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority.  Claims involved are usually subject to standardized procedures which lead to a settlement with limited exercise of discretion. Claims involved occasionally require analysis and may require research to resolve coverage and/or damage issues.  There is supervisory review of ongoing progress and results of work.  There is more focused supervision on all complex files.

Primary Purpose:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority. 

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.

  • Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary, may 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 submit 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 handle to conclusion
  • Identify customer needs and work to meet those needs using appropriate customer service skills
  • Develop an understanding of the functions of other departments, such as Policy Ops and Marketing

Trainee

  • Shadow and learn the above stated essential duties and responsibilities
  • Learn to handle most aspects of auto claims
  • Develop a basic understanding of the content of policies written by the company
  • Develop a basic understanding of the insurance industry and the organizational relationships of the company
  • Learn how to determine subrogation or fraud potential and how to handle
  • Develop a basic understanding of systems and technology used within the company

Level I

  • Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability
  • May handle more complex files with appropriate supervision to develop skills
  • Develop a working knowledge of systems and technology used within the company

Level II

  • Receive claim assignments and verifies/investigates coverage and documents all appropriate information
  • Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file
  • If handling PIP may participate in investigations of medical providers and attend EUOs
  • May work with attorneys in resolving lawsuits
  • Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level
  • Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
  • May assist in training of Claims Representatives
  • Proficient in using all systems and technology used within the company
  • May be required to make personal appearances on behalf of the company when requested

Senior

  • Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement
  • May inspect damaged property during an investigation
  • 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 other team members or serve as a mentor for others  
  • May assist with file reviews and audits
  • 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

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.

Job Requirements

About National General Holdings:

National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

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.