The Call Center Claims Representative is responsible for managing a high volume portfolio of insurance claims primarily via telephone and digital channels, from initial report to final resolution. This vital role involves conducting thorough phone-based investigations, interpreting policy coverage, negotiating settlements, and ensuring claims are processed accurately, promptly, and in compliance with all company and regulatory standards. Success in this position requires exceptional analytical skills, adherence to call center metrics (e.g., AHT, Quality), and superior customer service expertise.

Key Responsibilities

1. Claims Management & Investigation (Phone-Based)

• Handle Inbound/Outbound Calls: Professionally manage a high volume of calls to complete claims investigations, often navigating sensitive or complex situations over the phone.
• Determine Coverage & Liability: Accurately interpret complex insurance policy language and endorsements to determine coverage and establish liability via detailed telephone interviews with policyholders, claimants, and witnesses.
• Evaluation & Negotiation: Evaluate the extent of damages or loss, calculate claim reserves, and negotiate fair and equitable settlements with policyholders or claimants within assigned authority limits.

2. Customer Service & Efficiency

• First Call Resolution (FCR): Strive to resolve most inquiries and advance claims status during the initial call.
• Metric Adherence: Consistently meet or exceed established call center performance metrics, including Average Handle Time (AHT), Quality Scores, and Customer Satisfaction (CSAT) targets.
• Communication: Serve as the primary point of contact, providing clear, empathetic, and timely claims status updates and explaining complex policy terms in an easily understandable manner.

3. Documentation & Compliance

• Accurate Documentation: Maintain detailed, timely, and organized documentation of all telephone interviews, investigation findings, decisions, and correspondence in the claims management system.
• Regulatory Compliance: Ensure all claims handling practices adhere to relevant regulatory and legal requirements (e.g., Unfair Claims Practices Acts).