Sr. Complex Claim Specialist

Berkley • Overland Park, KS

10d

About The Position

We are seeking an experienced Sr. Complex Claims Specialist to join our team at Intrepid Direct Insurance. In this role, you will be responsible for handling complex and high-value insurance claims, providing expert guidance, and ensuring timely and accurate resolution. The successful candidate will have a deep understanding of insurance policies, exceptional problem-solving skills, and the ability to collaborate with various stakeholders.
Key functions include but are not limited to:
Claim Evaluation:
Evaluate and assess complex insurance claims to determine coverage, liability, and potential fraud, ensuring adherence to company policies and industry regulations.
Investigation:
Conduct thorough investigations, including gathering documentation, statements, and evidence, to support claims decisions and mitigate risks.
Communication:
Communicate effectively with policyholders, claimants, legal representatives, and other relevant parties to explain claim decisions, negotiate settlements, and address inquiries.
Collaboration:
Collaborate with internal teams, including underwriting, and actuarial departments, to ensure a comprehensive understanding of the claims process and contribute to process improvements.
Customer Service:
Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Reserving:
Establishes and maintains appropriate initial and subsequent loss and expense reserves throughout the life of the claim.
Litigation:
Develop litigation plan with defense or coverage counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Managing vendors involved with claim files, i.e. Independent Adjusters, Defense Attorneys, and Coverage Counsel

Requirements

• Bachelor’s degree and/or Juris Doctorate, preferred.
• Have, or ability to obtain adjuster license in required states
• 7+ Years of Commercial Claim Experience – Multiple Lines of Business, preferred.
• Claims handling experience in all lines of property and casualty commercial insurance
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills
• Excellent analytical and problem-solving skills
• Self-starting, self-motivating and capable of making decisions independently

Nice To Haves

• Insurance related designation (AIC, SCLA and/or CPCU), preferred.

Responsibilities

• Evaluate and assess complex insurance claims to determine coverage, liability, and potential fraud, ensuring adherence to company policies and industry regulations.
• Conduct thorough investigations, including gathering documentation, statements, and evidence, to support claims decisions and mitigate risks.
• Communicate effectively with policyholders, claimants, legal representatives, and other relevant parties to explain claim decisions, negotiate settlements, and address inquiries.
• Collaborate with internal teams, including underwriting, and actuarial departments, to ensure a comprehensive understanding of the claims process and contribute to process improvements.
• Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Establishes and maintains appropriate initial and subsequent loss and expense reserves throughout the life of the claim.
• Develop litigation plan with defense or coverage counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
• Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Managing vendors involved with claim files, i.e. Independent Adjusters, Defense Attorneys, and Coverage Counsel

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees