Senior Complex Claim Specialist

Position Location & Schedule Details

Position Duties & Responsibilities

• Manages a personal caseload of claims, which mostly include complex coverage claims and litigation, ensuring the proper adjudication or settlement of those claims.
  • May also provide supervision of bi-furcated claims as assigned by the Litigation & Legal Manager

• Performs various administrative tasks necessary for Complex Claim Unit operations, including, but not limited to:
  • Assignments of new complex claims and/or suits to team members or self
  • Managing Large Loss Notices for all claims assigned to the Complex Claims Unit
  • Preparing reports and/or agendas for Reserve Calendar and Complex Claims Unit Team meetings
  • Assisting Litigation & Legal Manager in vetting and approving outside counsel
  • Maintaining a list of available outside counsel for assignments
  • Receipt, review, approval, and or rejection of invoices from previously approved vendors
• Exercises sound judgment and decision making within authority level for reserving and settlement decisions with respect to personal caseload of claims, and in reviewing, approving, and/or rejecting reserve and/or settlement claim requests of other team members with lesser authority levels.
• Complies with all state and federal regulations, Core Values, and established processes and guidelines.
• Facilitates the claim process and resolves claims in a timely manner by initiating and maintaining positive and productive communication with all customers and claimants.
• Investigates, reviews/applies coverage/compensability, evaluates, and settles claims within the scope of the company’s contractual and legal obligations to ensure that settlements are fair and equitable to the insured, claimant, and the company.
• Ensures salvage and subrogation opportunities are identified and pursued in order to minimize claim losses.
• Utilizes all appropriate loss and expense savings programs and directs the activities of outside vendors to ensure only necessary and cost-effective work is accomplished.
• Accurately and thoroughly document all claim files in the Claim system of record to substantiate the disposition of the claim.
• Establishes and maintains appropriate case reserves sufficiently to fund the payment of the claim once resolved, whether through settlement, litigation, or arbitration.
• Identifies indicators of potential fraud and refers to the Special Investigations Unit.
• Interacts with insureds, agents, claimants, attorneys, and other service providers and experts, as necessary.
• Coordinates relevant claim information across departments such as Loss Control, Underwriting, and Marketing.
• Leads field investigations, where warranted or permitted in large claims, construction accidents, serious or certain other losses or particularly where the insured’s action(s) may be implicated or have contributed to the loss.
• Serves as a technical resource for other staff members with expertise in coverage issues, reserves, exposure, settlement value, and strategy.
• Provides guidance and mentorship to team members, including training, mentoring, and assisting in the development of team members' core technical and analytical skills.
• Participates in, and oversees, special projects and committees, as assigned.
• Secures and/or maintains appropriate state adjuster license(s) and continuing education credits, as necessary.
• Actively participates in professional development, including continuing education and self-improvement.
• Other duties as assigned by leadership, either verbally or in writing.

Candidate Requirements & Qualifications 

• Bachelor’s degree or equivalent insurance education and work experience are required.
  • Twelve years minimum of increasing claim experience, with knowledge in commercial and litigation claim handling.
  • Fifteen or more years with prior leadership experience in a claim handling setting is preferred.
• Professional designation or be actively working towards a designation is preferred.
• Demonstrated excellent verbal and written communications skills.
• Ability to work effectively both independently and in a team environment.
• Demonstrated customer service skills.
• Demonstrated critical thinking skills and the ability to be decisive.
• Ability to negotiate skillfully in demanding situations and effectively manage conflict while maintaining relationships.
• Demonstrated computer and operating system skills including proficient use of claim management systems and Microsoft Office products.
• Adapts easily to new or changing assignments, priorities, requirements, or situations.
• Demonstrated time management and organizational skills with the ability to prioritize and complete work and/or projects effectively.

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