Sr Claims Representative

Argo Group International Holdings, Inc.and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions.

Job Description

PURPOSE OF THE JOB: Provide a summary of the position, which includes the key reason the job exists. Include a statement about the kind of supervision or guidance the position generally requires (general direction, close supervision, etc.).
The representatives are responsible for the investigation, evaluation, negotiation and settlement of claims. This includes analyzing coverage; contacting the customers; investigating the facts surrounding the loss; arranging inspection, experts, and third parties; collecting information and evaluating the complexity of the loss of claims, when needed; negotiating loss settlements either directly with our customers or through their assigned counsel; and finalizing a settlement. Representatives are required to understand and comply with insurance regulations, statutes, and case law accordingly. The representatives work closely with other departments, vendors and the defense counsel, as needed, throughout the claim process. Depending on the level of complexity, claim values can range from a nominal amount to millions of dollars.
ESSENTIAL FUNCTIONS: List essential job functions/duties that employee(s) must be able to perform, with or without reasonable accommodation. These are the tasks or functions that are fundamental to the position (as opposed to marginal).
* Handles noninjury liability claims, which includes first- and third-party, repairable losses.
* Demonstrates the responsibility for handling first- and third-party claims, including injury and property damage.
* Processes Medicare supplement claim bills by reviewing the diagnosis, services rendered and the Medicare allowable under the plan's benefits, limitations and exclusions
* Handles multiple lines of business with a moderate level of complexity.
* Demonstrates an authority limit per claim basis for individual products and credit products.
* Demonstrates the responsibility for investigating coverage issues and/or liability, as needed.
* Confirms coverage and the facts of loss through the initial investigation.
* Determines the appropriate method of inspection or review of the facts.
* Makes the liability determination based on the investigation and the applicable liability law.

Ensures compliance with state regulations and requirements.
* Focuses primarily on proper fact-gathering, investigation and the resolution of all the claims of moderate complexity.
QUALIFICATIONS: List the minimum educational and experience qualifications, required proficiencies with specialized knowledge, computer proficiencies, required certifications, etc.
* Two years of claims experience.
* Maintain continuing education (CE) requirements for state licensing, when appropriate.
* Health - Completion of America's Health Insurance Plans (AHIP) or LOMA introductory courses.
* Completion of the appropriate training on the vendor and system application to ensure quality claim handling.
* Health - completion of the training or the basic customer service knowledge of the claim payment system and document routing software.
* Completion of basic Kaplan courses and/or Property & Liability Resource Bureau (PLRB) courses, as appropriate.
SPECIAL POSITION REQUIREMENTS: (Optional) Describe anything unusual about the work schedule or terms of employment such as: necessary travel, physical requirements, risk, hazard, unusual work hours, worksite changes, or related special conditions that may apply to the position.
* The position is physically comfortable; essentially normal office environment with acceptable lighting and temperature; the individual has discretion about walking, standing, etc.
PREFERENCES: (Optional) Include any preferred attributes for the position that are not absolutely required in the minimum qualifications (i.e. advanced degree, certifications/designations, multilingual, etc.).
* Bachelor's degree in a related field or the equivalent years of work experience.
JOB FAMILY:
Claims Representative
Senior Claims Representative
Note: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.