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The Claims Analyst II will perform a range of functions around the claims oversight and administration work in the receipt, review, and processing of claims received by Towne. This position will provide assistance to Towne’s field personnel, and assistance for some external customers, and to other workers in Towne’s Claims Dept, and for the outside claims TPAs, as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform all functions.

Descriptive Statement(s)

% of Time

Reviews claims documentation, including estimates and expense bills/invoices that are received from various sources pertaining to claim files.  Analyzes, reviews, and oversees claims within designated dollar thresholds, and consults with the Claims Manager or others in the dept for assistance as needed.  Performs other duties as assigned.

10

Communicates with Towne’s field personnel, and with other internal Towne staff, and with the claims TPAs and outside lawyers, and insurance companies, and other vendors, as needed.  Performs other duties as assigned.

10

Acts as liaison between corporate and field offices to coordinate the gathering of information that will facilitate proper responses to the claims TPAs and defense counsel.  Handles inquiries and requests from outside attorneys, insurance companies, and individuals in connection with any claim files or other matters that the Claims Dept needs to deal with.  Handle incoming phone calls and incoming emails.  Performs other duties as assigned.

20

Comply with all State and federal laws, and all company policies and procedures.  Assists inside and outside people and entities with questions and various inquiries regarding claims and/or payments.  Assists with rental car assignments.  Sets up new claim files in the Towne systems, when requested.  Performs other duties as assigned.

10

Documenting of claim files in the internal Towne system(s).  Dealing with collections and subrogation matters, which sometimes involves Arb Forums intercompany arbitration.  Initiate necessary correspondence for demand of reimbursement, and respond to incoming demands for reimbursement from subrogating entities.  Transmit documents and other items to the claims TPAs that are utilized by Towne.  Performs other duties as assigned.

10

Responding to the frequent requests for information, status, and updates from Towne field personnel.  Those responses will be done via email or Teams messages, or by phone, etc.  Works independently and sometimes in a group, to handle and complete special projects, as assigned.

30

Partners with Claims Manager and Claims Director to provide support for various claims, including some claims in litigation. Provides claims TPAs with settlement authority up to $25,000.  Partners with Claims Manager and Claims Director on projects and development of procedural and process documentation.  Performs other duties as assigned.

10

The total amount of time for all functions of the job

100%

Education:

• High school diploma or general education degree (GED).  Some college preferred.

Required Licensure, Certification, etc:

• N/A

Work Experience:

• Six to twelve months (or more) insurance claims related experience.

Knowledge:

• Strong understanding of insurance claims processes and procedures.

• An interest and willingness to learn about claims and litigation topics that pertain to the company and the dept.

• Understanding of self-funding, self-insured retentions, and third-party administrating (TPA) concepts.

Skills:

• Computer proficiency and technical aptitude with an ability to utilize advanced functions of MS Office (Excel, Word, and Outlook), the internet and various internal and external Claims applications and databases.

• Excellent verbal and written communication skills, and the ability to communicate effectively with internal Towne personnel and external customers, vendors, business partners, and attorneys.

•  Ability to work independently to effectively prioritize and plan work activities, and using time efficiently and developing realistic action plans to accomplish required tasks.

• Ability to manage several projects simultaneously while working under pressure to meet deadlines.

• The individual identifies and resolves problems in a timely manner and gathers and analyzes information skillfully.

• Ability to exercise good judgment and discretion in the processing and documenting of claim files.

• Ability to read, analyze, and interpret general business correspondence, instruction guides, and training materials.

• Ability to speak clearly and persuasively in positive or negative situations, and have group presentation skills, and participates in meetings.

• Ability to read and interpret documents and procedure manuals.  Ability to write routine correspondence.

• Ability to add, subtract, multiply, and divide.

• Ability to define problems, and collect data, establish facts, and draw valid conclusions.

• Ability to interpret an extensive variety of instructions in written or diagram formats.

• Performs other duties as assigned.

Authority to Act:

• The worker follows established practices and procedures.  Duties are performed with and without specific directions given.  Work is checked or verified on a frequent or periodic basis.  Decisions are made within operational instructions and dept guidelines.  Worker will be given specific limits for providing Reserve and Settlement authority to the claim TPAs.

Budget Responsibility:

• None.  The worker will have control over resources available only.

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

Physical Requirements

While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to sit or stand for extended periods of time and may be required to run, walk, handle objects and tools and controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Lifting Requirements

There should be very little lifting with this job.  But might need to periodically lift up to 20 pounds, or move objects weighing up to 50 pounds.

Working Environment

The majority of work will be performed in climate-controlled environment, but may be exposed to inclement weather and varying degrees of temperatures when traveling.

Travel

Travel of up to 5% of the time.