Complex Claims Specialist (Remote)
About The Position
The purpose of this position is to provide direct handling of the company’s most complex and challenging claims. Responsibilities of this position include coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims. Candidate must possess strong litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The individual in this position will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority with exceptional standards of performance. This individual should possess strategic though process skills to effectively and efficiently manage loss exposures. Job duties will include communication and collaboration with key stakeholders, training, development and providing thought leadership where requested. In addition, position may require travel to mediations, arbitrations, settlement conferences, trials or other proceedings which may account for up to 20% of the specialist time. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.
Requirements
- Experience in complex coverage analysis and significant large loss evaluations.
- Superior communication and strategic negotiation and claim disposition skills along with proven problem-solving skills.
- Excellent presentation skills and moderate proficiency with standard business-related software (including Microsoft Outlook, Work Excel, and PowerPoint).
- Sufficient keyboarding proficiency to enter data accurately and efficiently.
- Multi-State licensing with strong understanding of Medicare reporting & compliance preferred.
- Must have valid state-issued driver’s license in good standing and be able to drive an automobile.
- 8+ Casualty claims handling experience (of those, a minimum of 5 years handling cases of a complex nature with a primary P&C carrier).
Nice To Haves
- College degree preferred.
- JD (Law degree) preferred.
Responsibilities
- Effectively evaluate and resolve coverage issues for all lines of business and all liability claim types.
- Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information.
- Effectively and efficiently manage vendors and expenses.
- Timely analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary.
- Effectively evaluate, negotiate and resolve claims within delegated authority (ranging from $100,000 to $400,000) utilizing the appropriate denials or releases.
- Provide required reports to claims, underwriting, reinsurance and actuarial on significant exposure cases.
- Report on all cases going to trial on a timely basis and attend portions of trials when warranted or where requested by management.
- Ensure proper referrals and timely updates to appropriate Reinsurer(s).
- Ability to handle or oversee Extra-Contractual, EPLI, Social Services and E&O claims against the Company.
- Must be able to drive an automobile to travel within territory. Car travel represents approximately 10-25% of employee’s time and a valid driver’s license.
- Travel, including air travel with overnight stays, is about 10% of the job
Benefits
- competitive base salary
- incentive plan eligibility at all levels
- comprehensive health care plans
- retirement savings plan with company match
- discounted Employee Stock Purchase Program
- tuition assistance and reimbursement programs
- 20 days of paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
