Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, umbrella claims, punitive damage claims, severe injury, long duration indemnity, permanent total disability, structural building damage, multiple location damage, including business income exposure and other extensive exposure claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense attorney. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives.
I. Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle all claims in accordance with state and federal laws.
II. Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner. Deny losses within authority level, providing detailed explanation, citing facts, and policy language.
III. Perform a thorough investigation based upon the type, complexity, and severity of the claim. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the potential high exposure and extensive damages, including potential full or partial liability and compensability denials. Formulate and document an action plan based on the covered damages and injuries.
IV. Determine and set reserves based on the most probable outcome of the claim, within authority level. Evaluate and negotiate directly with insured, claimant, or claimant’s attorney on all cases within authority level. Review claim facts and exposure with claims management, as appropriate, to guide claim strategy. Make complete, accurate, and timely payments within authority for covered losses.
V. Maintain a professional, courteous, and helpful approach when communicating in-person, on the phone, or through email and other correspondence with internal and external customers, business partners, and brokers.
VI. Provide knowledge and guidance to other claim handlers regarding claim strategy, coverage interpretations, and in-depth jurisdictional and legal nuances. Field questions from team members related to coverage/compensability decisions.
VII. Investigate and refer identified claims to Loss Recovery Services, as applicable.
VIII. Direct work of defense attorney through collaboration on claim strategy and resolution. Ensure defense attorney is adhering to Litigation Management guidelines. Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim.
IX. Engage in direct investigation, control, and settlement negotiations when outside adjusting and legal services are not necessary or available.
X. Attend mediations, depositions, and trials. Present complex claim files during roundtables and claims committee meetings.
1. Prior Experience:
Eight or more years in technical insurance claim roles with increasing responsibilities is required.
- Bachelor’s degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
- Evidence of continuing education in the insurance industry is required.
- Additional legal education or law degree is highly desirable.
- Completion of AIC and/or CPCU is preferred.
3. Necessary Knowledge and Abilities:
- Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
- Advanced knowledge of recoveries such as subrogation, reinsurance, apportionment, and deductibles.
- Advanced knowledge of reinsurance contracts, workers compensation pools, second injury funds, etc.
- Advanced negotiation skills.
- Strong listening, verbal, and written communication skills.
- Advanced knowledge of policy terminology, legal principles involving insurance, and emerging industry trends.
- Effective planning and organization skills.
- Ability to travel to inspect loss sites, attend mediations, depositions, etc.
Job Type: Full-time
Pay: $33,278.66 - $73,511.73 per year
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Professional development assistance
- Retirement plan
- Tuition reimbursement
- Vision insurance
- Monday to Friday
Work Location: One location