Complex Claims Specialist

Athens Administrators • Lake Mary, FL

1d • Hybrid

About The Position

Athens Administrators is hiring a full-time Complex Claims Specialist for its Property and Casualty department. The role reviews, investigates, analyzes, and processes complex, typically high-exposure claims within assigned authority and in accordance with policy and legal requirements. Claims often involve litigation and complex coverage issues. The position aims to provide quality service while protecting clients’ interests and focuses on commercial business across multiple coverage lines.

Employees living less than 26 miles from the Concord, California; Orange, California; San Antonio, Texas; or Lake Mary, Florida offices must work in the office once a week. Other days may be worked remotely if technical requirements are met and the employee lives in a state where Athens operates. Work from home is permitted if technical requirements are met. The schedule is Monday through Friday, 37.5 hours per week; offices are open Monday through Friday from 7:30 a.m. to 5:30 p.m. local time.

Requirements

• High school diploma or GED.
• At least 10 years of complex or major claims experience, including proficiency investigating and resolving severe-to-major casualty and general liability claims.
• A license from the state of residence or designated home state; maintain licenses and continuing-education requirements in all states.
• Additional state adjuster licenses may be required within 180 days.
• Experience with relevant insurance laws, codes, and procedures.
• Experience with property and casualty insurance policies and insurance tort laws, codes, and procedures.
• Understanding of auto and general liability exposure and unique coverage endorsements.
• Understanding of medical and legal terminology and liability concepts.
• Strong investigation and resolution skills for severe-to-major casualty claims.
• Time-management and project-management skills.
• Strong negotiation and litigation-management skills.
• Well-developed verbal and written communication skills and strong attention to detail.
• Excellent organization and ability to multitask.
• Ability to type quickly and accurately for prolonged periods.
• Proficiency in Microsoft Office Suite and ability to learn additional computer programs.
• Reasoning, problem-solving, and analytical skills, including researching and analyzing facts, identifying issues, and recommending appropriate resolutions.
• Trustworthiness, dependability, and a team-oriented approach.
• Ability to pursue innovative strategies and methods in support of service and results.
• Professional and friendly care and concern for team members and clients, and integrity in challenging situations.
• Ability to reliably commute to meetings and events as required.

Nice To Haves

• Associate of Arts or Associate of Science degree, or a Bachelor of Arts or Bachelor of Science degree.
• At least one adjuster license in New York, Texas, or Florida.

Responsibilities

• Analyze, investigate, and evaluate losses to determine coverage layers, settlement value, disposition strategy, claim merits, or denial of liability.
• Establish and regularly review indemnity and expense reserves within settlement authority, and recommend reserve levels for claims outside that authority.
• Prepare comprehensive reports and communicate claim trends and account or policy issues to clients and senior management.
• Manage litigation, including retaining selected counsel and following litigation guidelines for budgets, bill review, and payment.
• Document and manage claims from inception to closure, including statements, diaries, and reports.
• Ensure coverage memorandums and payments are appropriate.
• Coordinate with vendors and professional service providers, including legal professionals, industry experts, county officials, and client executives.
• Facilitate communication among insured entities, claimants, client contacts, and attorneys to resolve severe and complex claims.
• Lead comprehensive claim reviews and case-analysis discussions with committees or district-level authorities.
• Provide superior customer service to all levels of authority within the county.
• Meet with clients, attend hearings, and assist senior management with planning, forecasting, and potential new business opportunities.
• May assist management with hiring account-dedicated examiners.
• Provide guidance and technical expertise to less experienced examiners and may conduct meetings or training to support their development.
• Attend required meetings and educational seminars for professional development.
• Conduct on-site or frequent claim reviews with client representatives as required.
• Maintain required licenses.

Benefits

• Medical insurance
• Vision insurance
• Dental insurance
• Life and AD&D insurance
• Long-term care insurance
• Critical care insurance
• Accidental insurance
• Hospital indemnity insurance
• Health savings account and flexible spending account options
• 401(k) and Roth 401(k)
• Company-paid short-term and long-term disability
• Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED