AVP- Complex Claim Specialist

The Travelers Companies•Tower, MN

58d

About The Position

Investigate, evaluate, reserve, negotiate and resolve the company's most severe and/or complex claims, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, negotiating and resolution. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This may include a specific assignment as a severity management resource to one or more field offices.

Requirements

High School Degree or GED.
5 years bodily injury litigation claim handling experience or 10 years litigation experience.
In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
Generally, license(s) are required to be obtained within three months of starting the job.

Nice To Haves

College degree preferred or equivalent business experience.
5-10 years experience handling serious injury and complex liability claims preferred (casualty claim operations environment determining coverage, liability, investigation, research, evaluation, negotiation and settlement).
Position requires a proficiency in oral and written communications.
Advanced communications skills are required to understand, interpret and convey highly technical information in simple terms to others.
Thorough understanding of product lines, objectives of claim management, and legal theory issues involving claim resolution.
Familiarity with commercial lines/personal lines products, policy language, exclusions, ISO forms, effective claims handling practices.
Extensive experience handling large exposure and/or complex liability claims.
Familiarity with commercial lines products, policy language, exclusions, ISO forms, effective claims handling practices.
Thorough understanding of the litigation process, relevant case and statutory law.
Ability to recognize, analyze and advise on complex coverage, liability and damage issues.
Expert written and verbal communication skills to understand, synthesize, interpret and convey complex data.
Create and manage positive working relationships with business and marketing partners.
Ability to analyze and effectively respond to human resource issues.
Utilize technology as a strategic tool.
Ability to make independent decisions up to $1,000,000 without involvement of supervisor.
Competencies:
Leading the Business - Drive Results.
Leads Change - Executes Business Strategy.
Leading Others - Attract Top Talent, Maximize Individual Performance, Holds Others Accountable, Aligns Rewards, Creates and Sustains a Dynamic Workplace.
Leading Self-Emotional Intelligence - Demonstrates Self-Awareness, Initiative and accountability, Applies Critical Thinking, Communications Effectively & Influences Others, Exhibits Courage, Conviction & Credibility.

Responsibilities

CLAIM HANDLING:
Directly handle the Company's most severe and complex claims when Travelers has coverage of $2 million or greater and file exposure is greater than $2 million.
Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.
Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
Complete outside investigation as needed per case specifics.
Actively engage in the identification, selection and direction of appropriate internal and./or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants and fire or fraud investigators and other experts.
Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Utilize diary management system to ensure that all claims are handled timely.
At required time intervals, evaluate liability & damages exposure.
Establish and maintain proper indemnity & expense reserves.
Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.
Apply the Company's claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.
Develop and employ creative resolution strategies.
Effectively and efficiently manage both allocated and unallocated loss adjustment expenses
Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.
Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives.
Ensure that the right resources are being applied to each claim to achieve the best result at the most optimal cost.
LEADERSHIP:
Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
Field Severity Support: Some Complex Claim Specialists may be responsible for all or some of the following:
Collaborate with field severity units in the management and evaluation of some of the Company's severe and complex liability claims by providing claim handling guidance, recommendations and strategies to Field Product Line Managers, Unit Managers, and Major Case Specialists, for timely, cost effective resolution of liability major cases.
Provide mentoring or training as request by field severity management.
COMMUNICATION/INFLUENCE:
Consult with Manager on use of Claim Coverage Counsel as needed.
Provide guidance to underwriting business partners with res accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
Recommend appropriate cases for discussion at roundtable.
Attend and or present at roundtables/authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws
Obtain and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.
Assist underwriting business partners in marketing and account-contact.
Actively participate in the coverage, liability and damages analysis and development of creative resolution strategy for severity cases handled in the field.
Assist in the recognition of available defenses to contain loss payout and setting of appropriate reserves.
Regularly and actively participate in field severity roundtables to share expertise and recommendations in all aspects of severe claim management.
Collaborate with the severity unit in compliance with company claim policies, procedures, practices and standards for the handling of cases that meet the Critical Claim referral guidelines.
OTHER ACCOUNTABILITIES:
Apply expert litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
Recognize and implement alternate means of resolution.
Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.
Track and control legal expenses to assure cost-effective resolution.
Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.
Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Closely monitor independent counsel to ensure quality product.
Actively participate in periodic file quality reviews.
Appropriately deal with information that is considered personal and confidential.
Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers.
Perform other duties as assigned.

Benefits

Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

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