Senior Claims Analyst

Clear Blue Insurance Services Puerto Rico LLC•Charlotte, NC

11d

About The Position

The Senior Claims Analyst will utilize experience within commercial property and casualty claims to manage, monitor and assess complex claims activity of Third-Party Administrators (TPAs); use direct systems to access and monitor claim files, denials, reservations of rights, and settlements conducted by TPAs; ensure that the TPAs are performing within their authority, pursuant to agree upon processes and practices, within the agreed upon territories and market segments; ensure compliance with internal policies and regulations; consult with the Chief Risk Officer, Legal, Compliance, Finance, Underwriting, and IT departments to identify specific trends or problems within a program; keep records of all monitoring activity and report to the management team, support data-driven decision making with quantitative and qualitative measures and assessments.

Requirements

Bachelor’s degree in business, Finance, Risk Management, Insurance, or equivalent related experience
Five (5) + years of experience in claims analysis or a related role, preferably in a senior or lead capacity.
Three (3) +years of experience in claim handling, relevant litigation, or TPA management.
Strong analytical and problem-solving skills with high attention to detail.
Proficient in claims systems, Excel, and data analysis tools.
Demonstrated success in evaluating claims, making coverage determinations based on policy provisions, and managing litigation.
Some travel is required and will vary depending on business needs and caseload.
Excellent written and verbal communication skills.
Ability to manage multiple priorities and work independently under tight deadlines
Knowledge of insurance policies claims regulations, and industry best practices.
Strong interpersonal skills and ability to work cross-functionally.

Nice To Haves

Industry certifications (e.g., AIC) preferred.

Responsibilities

Provides front-line oversight of Third-Party Administrators’ personnel through direct communication and monitoring claims online using the Third-Party Administrators’ claim systems.
Identifies, analyzes and discusses monthly loss run trends, reportable claims and/or problematic claims.
Provides excellent claim service to external clients and internal partners.
Participates in claim file reviews with agents, brokers and Third-Party Administrators’ claim personnel.
Interfaces with Clear Blue and external underwriting on claim status, exposures, and other factors impacting their risks.
Reviews and approves Third Party Administrators’ monthly claim handling fee.
Prepares and presents internal management reports for large losses and large loss potential; usually over $250,000.
Conducts remote and onsite claim file audits of Third-Party Administrators.
Performs other duties as required by management including reinsurance and subrogation.
The responsibilities of this position require continuous interaction internally (executive team, managers, supervisors, and fellow associates) and externally (with TPAs, managing general agents, reinsurers, and brokers/intermediaries).