Senior Complex Claims Specialist
About The Position
The Senior Complex Claims Specialist is the most senior technical role in the organization. This person adjudicates assigned claims within given authority and provides operational support to the claims team. This person also: With minimal supervision, adjusts to resolution the highest severity claims and drafts the most complex technical coverage analysis and letters required in the given claim department Acts as subject matter expert within the team Leads litigation best practices and strategy including attending and leading trials and mediations Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions Identifies and provides potential solutions for emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with special investigations unit Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities Mentors other team members Develops content and conducts training for claims team and underwriters as requested Reviews and analyses claim documentation and legal filings
Requirements
- 10+ years of claims handling experience within General Liability & Bodily Injury
- A JD from an ABA accredited law school may be considered as a supplement to claims handling experience
- Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation
- Expert knowledge of coverage within the team’s specialty or focus
- Expert knowledge of litigation process and negotiation skills
- Proven track record of mentoring others
- Excellent verbal and written communication skills
- Advanced analytical skills
- B.A./B.S degree from an accredited College or University preferred
Responsibilities
- Adjusts to resolution the highest severity claims and drafts the most complex technical coverage analysis and letters required in the given claim department
- Acts as subject matter expert within the team
- Leads litigation best practices and strategy including attending and leading trials and mediations
- Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
- Identifies and provides potential solutions for emerging exposures and claims trends
- Identifies suspected fraudulent claims and tracks with special investigations unit
- Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
- Mentors other team members
- Develops content and conducts training for claims team and underwriters as requested
- Reviews and analyses claim documentation and legal filings
Benefits
- Competitive salary and bonus (based on personal & company performance)
- 401(k) with competitive company matching
- Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
- Company paid group term life, short-term disability and long-term disability coverage
- 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
- Paid parental leave
- 4 week paid sabbatical after every 5 years of service
- Financial Adoption Assistance and Medical Travel Reimbursement Programs
- Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
- Company paid subscription to Headspace to support employees’ mental health and wellbeing
- Recipient of 2024 Cigna’s Well-Being Award for having a best-in-class health and wellness program
- Dynamic, creative and values-driven culture
- Modern and open office spaces, complimentary drinks
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
