Complex Claims Specialist, Managed Care, E&O, D&O

Liberty Mutual•Weatogue, CT

54d•Hybrid

About The Position

Liberty Mutual has an immediate opening for a Complex Claims Specialist with Managed Care, Errors & Omissions (E&O) and Directors & Officers (D&O) Professional Liability claims experience. The Complex Claims Specialist, with minimal supervision, handles a book of specialty lines claims under E&O and D&O policies issued to health plans and other Managed Care Organizations throughout the entire claim's life cycle. In this role, you will be responsible for conducting investigations, evaluating coverage, setting adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business. This position may have an in-office requirement and other travel needs depending on candidate location. If you reside within 50 miles of one of the following offices, you will be required to go to the office twice a month: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; Westborough, MA; or Weatogue, CT. Please note this policy is subject to change.

Requirements

Bachelors' and/or advanced degree
7 + years claims/legal experience, with at least 2 years within a technical specialty preferred (Managed Care, Errors & Omissions and Directors & Officers)
Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge
Functional knowledge of law and insurance regulations in various jurisdictions
Demonstrated advanced verbal and written communications skills
Demonstrated advanced analytical, decision making and negotiation skills

Responsibilities

Analyzes, investigates and evaluates the loss to determine coverage and claim disposition.
Utilizes proprietary claims management system to document claims and to diary future events or follow up.
Issue detailed coverage position letters for all new claims within prescribed time frames.
Within prescribed settlement authority, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level.
Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting.
Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment.
Pro-actively manages the case resolution process. Actively participates in mediations and arbitrations, as well as negotiation discussions within limit of settlement authority.
Participates in the claims audit process.
Provides claims marketing services by meeting with brokers and insureds.
As required, maintains insurance adjuster licenses