Complex Claims Specialist

Athens Administrators • Lake Mary, FL

2d • Hybrid

About The Position

Athens Administrators has an immediate need for a full-time Complex Claims Specialist to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). This position does allow for work from home if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week. The Complex Claim Specialist is responsible for the review, investigation, analysis, and processing of complex claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure and often entail litigation and complex coverage. There is particular emphasis on runoff program claims for this desk. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines.

Requirements

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred
• Additional State Adjuster License(s), may be required within 180 days
• Maintain licenses and continuing education requirements in all states
• Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims
• Experience with relevant insurance laws, codes, and procedures
• Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures
• Understanding Auto and General Liability exposure and unique coverage endorsements
• Understanding of medical, legal terminology and liability concepts
• Proficiency in investigation and resolution of severe to major level casualty claims
• Time Management and project management skills
• Strong negotiation and litigation management skills
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly, accurately and for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
• Must be able to reliably commute to meetings and events as required by this position

Nice To Haves

• AA/AS or BA/BS preferred but not required
• Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred

Responsibilities

• Advanced knowledge in the following areas: 1) Complex Auto or General Liability claims handling concepts, practices and techniques, to include but not limited to complex coverage issues, and product line knowledge, 2) advanced, functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills.
• Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability
• Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level
• Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management
• Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment
• Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure
• Ensure appropriateness of all coverage memorandums and payments
• Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications
• Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims
• Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities
• Provide superior customer service to all layers of authorities within the county
• Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account. May assist management in hiring other account dedicated examiners
• Provide guidance and serve as a technical expert to less experienced examiners
• May conduct meetings or training sessions to help develop less experienced examiners
• Attend all required meetings and educational seminars for professional development
• Maintain required licenses

Benefits

• We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more!
• Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

What This Job Offers

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