General Liability Manager

Chedraui USA•Commerce, CA

2d•Onsite

About The Position

The primary role of the Claims Manager, General Liability is to manage and support the company’s claims management programs and processes, including management of the work of the third-party claims’ administrators and related claims consultants. This position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability Bodily Injury, Property Damage and Subrogation claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage/CRT, investigation, evaluation, reserving, litigation management, negotiation, resolution and subrogation) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources and serves as a contact and technical resource to the field and our business partners. Provides quality customer service and ensures file quality and timely liability analysis.

Requirements

Bachelor's degree (B. A.) from four-year college/university or equivalent combination of education and experience
minimum of five years related experience and/or training.
Experience should include work in a high-volume claims environment or working for a third-party administrator or insurance carrier claim department.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to clearly write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the public.
Spanish speaker required.

Responsibilities

Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as store employees, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential
Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as, nurse consultants, social media checks, SIU investigators, medical canvas and other experts.
Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
Maintains claim files and documents claim file activities in accordance with established procedures.
Utilizes diary management system to ensure that all claims are handled timely.
Establishes and maintains proper indemnity and expense reserves.
Recommends appropriate cases for discussion at roundtable.
Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others
Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance
Develops and employ creative resolution strategies.
Responsible for prompt and proper disposition of all claims within delegated authority.
Negotiates disposition of claims with claimants.
Recognizes and implements alternate means of resolution.
Manages and oversees In-house/attorney represented and litigated claims
Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers
Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
Tracks and controls legal expenses to assure cost-effective resolution.
Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed
Represents the company as a technical resource, attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws
Actively provides mentoring and coaching to less experienced staff to increase the technical expertise and improve bench strength.
Shares accountability with business partners to achieve and sustain quality results.
Evaluates all claims for recovery potential; directly handles recovery efforts and/or engages and directs company resources for recovery efforts
Responsible for oversight and management of all claims management processes – settlement of claims, claims reporting, claims activity management, claim investigation and resolution.
Interfaces regularly with third party claims administrators and insurance carriers’ claim teams to ensure that the claims management processes operate efficiently and effectively.
Works with the third-party administrator to ensure that they maintain compliance with all required claims handling instructions, regulations, and laws.
Provides relevant internal and external reporting of claims data to operating, financial and executive management.
Supports internal budgeting and accounting processes related to claims to ensure that the company’s claims related expense payments and balance sheet accruals are timely and accurate.
Provides support to the actuarial claims’ valuation process on an ad hoc basis to support explanations about changes in claims values.
Leverages data analytics to facilitate optimal outcomes.
Perform other duties as assigned
Directly supervises third party vendors that assist with claims handling.
Carries out supervisory responsibilities in accordance with the organization's policies, procedures, and applicable laws.
Responsibilities include interviewing and training the third-party administrator employees; assigning claims and directing work; reviewing the performance of the claim’s adjusters, addressing complaints, and resolving problems.