Hybrid Senior Claims Advocate at Cross Family of Agencies

The Claims Advocate role is multifaceted with responsibilities encompassing technical claim management, strategic loss analysis, process improvement, and strong customer service.  While the Claims Advocate is primarily responsible for management of claim issues on behalf of our clients, they are also expected to support the overall office goals regarding new business and client stewardship.

The Claims Advocate is expected to assist clients with Risk Management strategies that improve the quality and consistency of claim outcome.  Specific to client engagement, the Claims Advocate will understand the needs of the client and proactively provide a service that create efficiencies, compliance, and adds value to the overall client relationship.  They will also support commercial lines customers with claim reviews, loss trend analysis and identification of loss avoidance opportunities.  

Additionally, the Claims Advocate will be an active member of the Client Service Team assisting with the overall risk management of their clients.  Since Claims Advocates have a distinct role as part of the overall client service team, they are expected to conduct their activities proactively and with minimal management oversight, but fully accountable to the service team for their individual responsibilities.
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Duties of the Claims Advocate include, but are not limited to: 

I.    Identify all of the Client’s insurance policies and understand claim reporting requirements for each.
.    Develop a Claim Reporting Reference guide (Claim Kit) to assist the Client when self-reporting or notifying the Broker of a Claim.
.    Communicate with clients and other individuals to collect the information necessary to submit a claim notice to the insurance company/companies.
.    When appropriate, enter claim information in AMS and produce a loss notice. 
.    Report claim(s) to the insurance company/companies by phone, e-mail or fax. 
.    Create a diary item/suspense in AMS to obtain the assigned adjuster’s contact information, the assigned claim number, and a loss reserve amount, 7 days from the submission of the loss notice; enter this information in AMS.
.    For Claims-Made coverages, provide clients with instructions regarding identification of potential claims and reporting assistance prior to end-of-policy term.

II.    Assist the Client with understanding the Claim process and providing necessary information to assist in the adjustment process.
.    Discuss and explain the Claim Process to properly calibrate the client’s expectations on timing, deliverables, and recovery/results.
.    Facilitate communication and direct activity between the carrier, client, employee, claimant, etc., that achieves problem resolution.
.    Determine settlement strategies including any potential for third party recovery.
.    Assist with the presentation of a third party claim, as appropriate. 
.    Review claim determinations received from adjusters for compliance with policy conditions and handle coverage disputes.
.    For those claims you are directly involved as an advocate for the client you will request the status of claims 30 days after submission and enter the updated information (including any changes) in AMS. Continue updating the status of a loss (making sure to document AMS with all activity on the claim and attaching all related documentation) as long as necessary until the claim is closed.

III.    Negotiate with Carrier Adjusters in closing/reducing claims for Property, Liability, and, prior to unit Stat date, for Workers Compensation.
.    Ensure that loss runs and Mod Master (for WC) are requested in a timeframe allowing for financial impact to claim experience prior to unit Stat or renewal calculations.
.    Proactively perform loss trend analysis on Key Accounts to identify potential corrective actions regarding claim administration, and assist with the development of the client’s “Risk Profile Story” utilized during renewal negotiations.

IV.    Engage with Carriers regarding claim activity, claim development, and status of significant claims.  
.    Communicate updates of claim statuses and reserve amounts to Account Managers & Account Executives per the Cross Basic Procedures Manual.
.    Provide summary of observations, findings and recommendations to clients.

V.    Manage requests for Loss Runs and Claim Summary reports for Clients and Client Service team.
.    Ensure that loss runs are requested timely.
.    Provide claim summary reports where appropriate, and in a format that is useful/valued to the client.

VI.    Key Accounts:  Conduct Loss Data Analysis that identifies actionable Risk Control and Loss Mitigation opportunities, and present this information to the Client on a quarterly/annual basis.  This includes Experience Mod projections and Mod analysis.

VII.    Understand the Client’s business and unique needs around Claims Management.
.    Identify stakeholders within the client’s operation and what information is important for their needs.
.    Develop processes and services that maximize the impact of our Claim expertise on their operation.

VIII.    Align and manage Carrier Risk Management services which provide a cost benefit impact to the Client’s Risk Management program.

IX.    Develop and deliver educational training on Claim and Risk issues relevant to Clients and Colleagues.
.    Emerging issues and other topics that help improve overall risk management.
.    White-papers, presentations or drip-marketing delivery methods.

X.    Actively participate in identification and pursuit of new client business opportunities.  These opportunities include BOR as well as specific Claim or Risk Control service projects.

XI.    Professional Development and continuing education is required of all Claim Advocates.  In addition to maintenance of Insurance licensing the expectation includes learning new lines of coverage, technical development, and growing your presence in the local/regional insurance industry.  
 

DISCLAIMER:

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.