Senior Claim Specialist - Prime Specialty

CRC Group•New York, NY

32d•Onsite

About The Position

The Senior Claim Specialist analyzes and processes claims by gathering information and drawing conclusions. This role acts as a liaison between the insured and the insurance carrier to report, track, and manage the claims process. The position involves evaluating claims, reporting forms, and cancellations, initiating necessary corrections to ensure accuracy, and authenticating relevant activity on assigned files. The specialist will determine where new loss claims should be reported, manage all claim documentation, and use discretion to submit necessary information and/or correspondence to the Agent or Insurer to process claims appropriately. Additionally, the role involves analyzing claim coverage with insurance carriers for accurate payment, assessing the eligibility status of denied claims, anticipating and meeting customer needs, and maintaining the claims and suspense system. Processing all departmental claims in a timely manner according to company policy is also a key responsibility.

Requirements

Bachelor's degree with a concentration in business or equivalent work experience
New York adjuster license or New York attorney license
Three years of Claims handling experience and commercial and multi-line knowledge
Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations
Ability to make independent decisions following CRC guidelines with minimal or no supervision
Good organizational, time management, and detail skills
Extensive knowledge of insurance and CRC processes
Ability to maintain a high level of tact and professionalism
Good leadership skills to influence all departmental employees in a positive manner
Possess strong interpersonal skills
Strong verbal and written communication skills
Strong computer and office skills
Ability to work extended hours when necessary

Nice To Haves

Three years of GL claims handling experience
New York Labor Law Sections 200, 240, 241 preferred

Responsibilities

Evaluate claims, reporting forms and cancellations and initiate necessary corrections to ensure accuracy of dates, coverage, signature, commission, premium, attachments, etc.
Authenticate all relevant activity on assigned files and makes recommendation for additional activity as appropriate.
Determine where new loss claims should be reported.
Manage all claim documentation.
Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately.
Analyze claim coverage with insurance carriers to ensure claims are paid accurately.
Assess eligibility status of denied claims.
Anticipate and meets all customer needs (both internal and external).
Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources.
Process all departmental claims in a timely manner according to company policy.
Perform other duties as assigned.