WTP – Claims Examiner
Company: Zurich Insurance Group
World Travel Protection provides global travelers with specialist emergency assistance services when something goes wrong in their travels. We operate 24 hours a day, seven days a week from our 4 operation centers in Australia, Canada, China, and Malaysia, responding to the cries for help we receive from travelers across the globe.
Owned by Zurich, but with separately managed business entities, we can truly offer you a world of possibilities within assistance and insurance. Get ready to do your best work…and then some.
Investigate, evaluate and conclude low exposure, low complexity personal or commercial line claims by following established protocols to ensure that claims are handled in the most effective, efficient way while delivering a customer-centric claims service.
- Bachelor’s Degree and No prior experience required in the Customer Service area
- High School Diploma or Equivalent and No prior experience required in the Customer Service area
- Zurich Certified Insurance Apprentice including an Associate Degree and No prior experience required in the Customer Service area
- Microsoft Office experience
- Geographic flexibility
- Analytical skills
- Prioritization and multi-tasking skills
- Strong verbal and written communication skills
- Experience working in a team environment and collaborating across work groups
Job Accountabilities – Key Accountabilities
- Capture and update claim data/information in compliance with best practices for low complexity, low exposure personal or commercial line claims.
- Determine liability by gathering relevant facts, utilizing applicable law, and establishing basic principles of negligence.
- Confirm policy existence by identifying coverage on low complexity claims.
- Work to have a timely resolution to claims by developing case strategy, developing a case evaluation, escalating issues as appropriate, and providing status updates to ensure customer satisfaction.
- Establish timely reserves within authority limits by estimating the value of claims.
- Assess damages by calculating applicable damages or the range of damages allowed by law.
- Ensure customer service by proactively communicating information, responding to inquiries and following customer protocols.
- Manage expenses by working within vendor-approved networks and managing the scope of work assigned to outside contractors. Depart from approved vendors with manager approval, where in the best interests of the insured.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
- Protect Zurich’s reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.
- Follow established claims handling procedures for low complexity, low exposure personal or commercial line claims to ensure consistency and quality in claims services.
- Collect data and documents in an established system to facilitate the accurate assessment and value of claims.
- Input relevant data into established systems accurately so that analysis can be undertaken.
- Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
- Assess and appoint claims vendors within agreed authority limits aligned to the organization´s Claims Vendor Management strategy.
- Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and promote continuous learning.
- Provide feedback on business processes and systems to identify opportunities for improvements.
- May negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
- May participate in customer marketing efforts.
- May contribute to profitable growth by providing risk insight, information, and trends to Business units or customers as needed.
- Develop a practical understanding of how processes and systems in your own area of work related to the management of risk and compliance.
- Adhere to local regulatory and governance requirements throughout the life of a claim to ensure decisions are made using the right standards.
- Acquire and organize the relevant evidence and information to accurately assess the value of a claim.
- Provide feedback and recommendations for improvement of processes and systems.
- Respond to and resolve inquiries and problems, judging when to pass complex queries on to or involve others, to provide effective service and clear advice to colleagues and customers.
- Respond to queries from customers and/or colleagues to ensure customers receive appropriate advice.