PIP Telephone Claims Representative Trainee, I in New York, NY at National General Insurance

Date Posted: 5/20/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    New York, NY
  • Job Type:
    Claims
  • Experience:
    Not Specified
  • Date Posted:
    5/20/2018

Job Description


Primary Purpose:

Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority.   This position can be located either on a remote basis in the Albany, NY region or in the Buffalo, NY office.

 

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.

  • 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; process payments timely 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
  • Responsibilities include but are not limited to: reviewing a person’s injuries and loss of earnings claims after an accident; analysis of coverage and conducting investigation of injuries and causal relationship to claim; proactively interact with healthcare professionals to monitor treatment and disability and determine need for independent medical examinations; maintain cost containment practices regarding indemnity and expense payments on claims; negotiate claims with insured’s, claimants, attorneys and providers; recognize and investigate recovery possibilities; comply with state regulatory requirements and maintain work according to individual/company goals; work in a team environment; other duties as assigned.
  • 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
  • May oversee files that use, but not limited to: medical management tools, such as case management, independent medical examinations and peer review; may oversee large loss, litigation and catastrophic losses.  

 

Trainee

  • Shadow and learn the above stated essential duties and responsibilities
  • 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
  • Develop and learn the NYS Fee Schedule and a basic understanding of anatomical terminology associated with injury claims, CPT and ICD coding
  • Develop and learn NYS Regulation 68

 

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
  • Minimum Skills and Competencies:
  • The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
  • Successfully completes Claim Representative trainee program, or equivalent external training program
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Obtain/Maintain appropriate licensing or educational requirements as a New York State license is required or will be obtained within the 1st 90 days
  • Demonstrate proficiency in file audits to agreed standard of efficient claims quality
  • High degree of initiative, mature judgment, and discretion
  • Ability to resolve conflicts and empathize with customers is critical
  • Demonstrate professional oral and written communication skills
  • Organization and time management skills are critical for this position
  • Demonstrate an understanding of insurance law as it relates to claims 
  • Knowledge of no-fault regulatory requirements for the state of New York (NY)

 

 

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
  • Successfully completes Claim Representative trainee program, or equivalent external training program
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Obtain/Maintain appropriate licensing or educational requirements 
  • Demonstrate proficiency in file audits to agreed standard of efficient claims quality
  • High degree of initiative, mature judgment, and discretion
  • Ability to resolve conflicts and empathize with customers is critical
  • Strong negotiation skills
  • Demonstrate professional oral and written communication skills
  • Organization and time management skills are critical for this position
  • Demonstrate an understanding of insurance law as it relates to claims 

 

Trainee

  • Develop understanding of claim policies & procedures; refers questions to supervisor

 

Level I

  • Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
  • Has a basic command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
  • Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files

 

Desired Skills:

  • Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
  • Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing
  • Proficient in systems and technology used within the company (i.e. XactContents)
  • Knowledge of no-fault regulatory requirements for the state of New York (NY)
  • Demonstrates a basic understanding of medical terminology and functions of the human body.
  • Demonstrates a basic understanding of anatomical terminology associated with injury claims, CPT and ICD coding.
  • Selected candidates will be required to successfully obtain/maintain appropriate licensing and/or educational requirements

Job Requirements

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About National General Holdings:

National General Holdings Corp. 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.

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