Sr. Claims Technical Adjuster, Complex Claims

RiverStone International•,

5d•$82,500 - $137,500•Hybrid

About The Position

The Sr. Claims Technical Adjuster, Complex Claims, is responsible for complex evaluation, investigation, and resolution of claims involving high exposure liability, auto, employers liability and excess claims. This role requires advanced technical expertise to interpret coverage, assess liability and damages, and drive strategic claim outcomes.

Requirements

Minimum 7 years of experience handling complex liability claims.
Juris Doctor (JD) or prior experience representing insurance carriers in coverage disputes
In-depth knowledge of insurance coverage analysis, litigation management, and claim resolution strategies.
Strong negotiation, analytical, and communication skills, with the ability to effectively present and defend positions.
Proven ability to negotiate with attorneys and clearly articulate relevant medical, legal, and factual issues.
Excellent time management and organizational skills (including maintenance of a current and well-organized claim file and email in-box), with the ability to prioritize a demanding caseload.
Detail-oriented, analytical, and methodical, with strong decision-making and sound judgment.
Adaptable and accountable, demonstrating integrity and ownership of results.
Proficient in Microsoft Office applications, particularly Word, Excel, and PowerPoint.
Exceptional written and verbal communication skills, including the ability to convey complex information clearly and persuasively.
Must be legally authorized to work in United States.

Responsibilities

Manage a portfolio of complex claims from initial evaluation through final resolution, ensuring fair, timely, and cost-effective outcomes in line with company and regulatory standards.
Conduct detailed coverage analysis on historic liability policies and wordings, interpreting complex policy structures and reinsurance arrangements to assess coverage applicability and exposure.
Conduct historic policy investigations including policy reconstruction, as necessary.
Draft and issue timely and thorough reservation of rights and coverage position letters.
Assess liability, causation, and quantum using medical, legal, and technical reports to develop and execute sound claim strategies.
Direct and collaborate with external counsel, technical experts, and third-party administrators, ensuring effective litigation management, cost control, and alignment with overall claims objectives.
Lead negotiations and settlements within delegated authority, applying technical expertise, commercial acumen, and strategic insight to deliver optimal outcomes.
Develop and maintain strong relationships with insureds, brokers, reinsurers, and internal stakeholders, fostering transparent communication and collaboration throughout the claims process.
Ensure accurate financial management of claims, including reserve setting, payment processing, and participation in periodic reserve adequacy reviews.
Contribute to departmental projects and initiatives, including process improvement, data quality enhancement, and audit support for claims portfolios.
Stay current on legal, regulatory, and industry developments affecting latent injury claims.