Claims Representative - Professional Liability

Job ID
# of Openings


Job Title: Claims Representative – Professional Liability

Department: Commercial Lines or Claims

Reports To:  Sr. Claims Representative or Claims Manager

FLSA Status: Non-Exempt

Job Code: Admin II


Summary Administers professional liability and other property and casualty related claims information from nursing home and assisted living clients by phone, email and fax in order to report insurance claims; works with clients, adjusters, and Producers on claims status, problems, and questions. Experience with professional liability claims or medical case management desired.


Essential Duties and Responsibilities include the following. Other duties may be assigned.


Assists nursing home and assisted living clients of the agency in reporting and monitoring commercial lines claims, which includes taking initial loss notice, getting loss notice to the appropriate insurance company, communicating with insured on adjuster assignment, tracking claims payments, and following the claim until closed by the insurance company.


Conducts initial reviews of claims for any coverage questions, reviews any denial of coverage for accuracy and acts as a liaison between insured and insurance company adjuster.


Serves as contact for Adjuster and Insured for claims related issues.


Refers coverage questions to Claims Manager, Claims Consultant, Director of Claims, Account Executives or Account Managers.


Secures loss runs from carriers as requested. Prepares claims information for presentations as requested.


Resolves customer claim issues in coordination with Account Executives and Producers in order to reduce E&O exposure.


Provides claims packets to customers and prospects as requested.


Follows company policies and procedures with respect to all essential duties and responsibilities of the job.


Supervisory Responsibilities                                                   

This job has no supervisory responsibilities.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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.


Education and/or Experience                                                  

High school diploma or general education degree (GED); and a minimum of one to two years of professional liability or medical case management related experience and/or training; or equivalent combination of education and experience.


Certifications or licenses

Valid Adjuster license where required; Property and Casualty Agent license encouraged.


Other Qualifications                                                 

Prior experience in claims or insurance.


Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee must occasionally lift and/or move up to 10 pounds.


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