Claims Specialist I, Private Client (Work from Home)

Job Description Summary

Are you poised and ready for an exciting opportunity to resolve unique and challenging insurance claims? Our Private Client team operates as a niche, stand-alone business, supported by the scale and resources of the entire Nationwide enterprise. If you have the maturity, confidence and resourcefulness to provide an outstanding level of service to sophisticated and savvy customers, we want to hear from you!

As a Claims Specialist, you'll investigate claims that may include a combination of casualty, material damage and/or property for personal lines to reach settlements within limits of authority. We'll count on you to promote and provide outstanding customer service.

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Job Description

Key Responsibilities:

  • Handles all assigned claims promptly and effectively to conclusion, with moderate 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 excellent customer service.

  • Investigates claims by obtaining medical reports, appraisals, estimates of property damage and evaluates bodily injury claims. Coordinates and reviews work performed by independent adjusters.

  • Determines liability by acquiring data from interviews with persons associated with the case, recorded statements and police reports and documents the claim file.

  • Pays claims accurately, based on policy provisions, state mandates and/or fee schedules. Authorizes and/or approves all claim payments within granted authority, which may include litigation expense.

  • Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends special reserves where necessary.

  • Partners with Special Investigations Unit and Recovery to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial, or subrogation (property, material damage, casualty).

  • Prepares/reviews reservation of rights, non-waiver agreements and denials of coverage when appropriate.

  • Delivers an outstanding customer service experience to all internal, external, current and prospective customers.

May perform other responsibilities as assigned.

Reporting Relationships: Reports to Claims Manager,

Typical Skills and Experience:

Education: Undergraduate degree or equivalent experience preferred.

License/Certification/Designation: State licensing where required.

Experience: One to three years of related experience in customer service and/or claims handling. Multi-line or subject area experience preferred.

Knowledge: 

General knowledge of customer service principles. Demonstrated knowledge of claims handling and claims practices, insurance theory and practices, insurance contracts and their application and estimating. Familiarity with automated claims systems. Participation in technical insurance or industry coursework preferred, such as Chartered Property Casualty Underwriter (CPCU), ICAR, ASE.

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 to make decisions/resolve conflicts such as application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Organizational skills to effectively prioritize work. Command of written/verbal communication skills for contact and/or negotiations with policyholders, claimants, repair persons, attorneys, physicians, agents and the public in general. Ability to efficiently operate personal computer and software for claims-related and other business applications.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Staffing exceptions to the above must be approved by the hiring manager’s leader and Human Resources Business Partner.

Values: Regularly and consistently demonstrates the Nationwide Values.

Job Conditions:

Overtime Eligibility: Not Eligible (Exempt)

Working Conditions: 

Normal office environment. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple on-site responsibilities and/or for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements as the need arises.

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.

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.

Claims Specialist I, Private Client (Work from Home)

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