Duties:

• Claim Intake and Initial Processing
  • 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.
  • Reviews limited assignments, as well as assigned claims for applicable coverage, liability, and exposures.
  • 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.
  • Makes initial contact with insured and any other involved parties within the specified time frame, as outlined within department procedure.
  • Determines/confirms facts of loss, cause of loss, the identification of parties involved, and the existence of/extent of injuries and/or damages involved.
  • Reviews applicable policy forms/coverage documents, determine and explain available coverage and benefits, and address/resolve conflicts.
  • Establishes appropriate initial reserves on the computer claims-handling system within the specified time frame outlined within department procedures.
  • Investigates and handles losses in an appropriate, adequate, and thorough manner.
  • Obtains written or recorded statements as needed.
• Investigation and Documentation
  • Ensures that damages, scenes, etc. are inspected, photographed, diagramed, and properly documented. Secures and protects evidence, as required.
  • Obtains other documents and records, such as police and fire reports, contracts and legal agreements, medical bills and reports, etc.
  • Prepares and submits any required data and reports (such as injury index, Medicare), per department procedure
  • Determines liability based upon the facts and a working knowledge of the applicable Hawaii Revised Statutes and any other applicable laws.
  • Stays abreast of statute changes, case law decisions, as well as policy and coverage changes.
  • Evaluates damages and/or injuries considering applicable coverage, liability determination, and any other pertinent information developed within the investigation.
  • Negotiates settlements within the authority granted.
  • 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.
  • Recognizes third party liability and contribution, and the handling and resolve of loss accordingly.
  • Initiates deductible recoveries with an insured per policy/coverage.
• Communication and Reporting
  • Reviews questionable claims and all coverage issues with department management.
  • Communicates loss status to insured, claimant, or an attorney, as required by law or by department procedure.
  • Accurately processes financial transactions upon the applicable computer claims handling system, to include establishing or adjusting reserves and making payments within granted authority.
  • Prepares and submits requests and required reports, for increased financial authority, as required by department procedure.
  • Maintains a diary on all active claims with diary date established and addressed in line with department procedure.
  • 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.
  • Manages and directs any/all outside vendors (such as independent adjusters, contractors, repair shops, experts, or attorneys).
• Litigation and Legal Compliance
  • Handles claims and/or litigation cases, as assigned.
  • Follows prescribed litigation guidelines and procedures, including reporting requirements and legal fee review program.
  • Attends and participates in mediations, arbitrations, settlement conferences as directed.
  • Travels to the neighbor islands as required for inspections and client visits.
  • Informs Claim Supervisor of any/all oral or written complaints, and any coverage dispute.
  • Prepares and timely submits required reports as may be required by procedure, department management, the company, or a vendor of the company.

Education/Experience:

• 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. 
• College degree with credits in insurance related subjects preferred.
• Equivalent combination of education and job-related experience will be considered.
• Continuing education in insurance and job-related issues and subjects required

Certificates, Licenses, Registrations:

• Valid Hawaii Driver license and use of own vehicle required.
• State of Hawaii general adjusting license preferred.

Salary Range: $50,000.00 To $75,000.00 Annually