Complex Claims Specialist

Berkley•Jacksonville, FL

About The Position

The primary role of a Complex Claims Bodily Injury Specialist is to promptly and professionally ensure high quality claim handling by analyzing BI / liability of claim submissions while making coverage determinations, investigating losses, conducting independent assessment as to the insured’s exposure and moving cases towards timely resolution. You will be an effective source for help and support because of your deep knowledge and liability claim expertise. The Complex Bodily Injury Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team.

Requirements

Bachelor’s Degree
Demonstrates an advanced knowledge of commercial trucking bodily injury claims case handling practices, legal liability, general insurance policy coverage, and the state`s tort laws as normally acquired through a bachelor`s degree (or equivalent training) plus 5-10 years directly related work experience.
Ability to investigate and evaluate complex liability claims.
Ability to analyze available information and make effective decisions.
Ability to evaluate damages and negotiate fair settlements.
Advanced analytical skills.
Advanced knowledge of coverage within the team’s specialty or focus.
Litigation and mediation management experience required.
Excellent verbal and written communication skills.
Strong background in auto and general liability coverage analysis particularly involving commercial claims with complex issues.

Responsibilities

Adjusts and resolves complex to severe commercial trucking bodily injury claims that may also include all phases of litigation.
Plans and conducts investigations of high severity bodily injury claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate.
Assesses policy coverage for submitted claims and notifies the insured of any issues.
With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters.
Determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
Reviews and analyses claim documentation and legal filings.
Assesses actual damages associated with Bodily Injury claims and confidently conducts negotiation within assigned authority limits, to settle claims.
Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company.
Acts as senior technical professional on team, assisting team members with escalated issues.
Develops and maintains excellent rapport with our agency force, insureds, claimants, experts, attorneys, and internal customers
Attend mediations, trials, and overnight travel as needed.