Complex Claims Specialist

About the role

To direct and oversee the investigation, evaluation and resolution of Commercial General & Automobile Liability claims outsourced to a third-party administrator (TPA).

Responsibilities

• Evaluates the Company’s exposure and decides the appropriate course of action to best protect and prevent undue loss, mitigate associated costs and provides reserve and settlement recommendations in accordance with Company policy.
• Acts as a liaison between TPAs, legal counsel and vendors to manage claims, including attending trials, arbitration, mediations, ADR and face-to-face negotiations.
• Provides technical direction and training to TPAs, outside counsel and department members to ensure compliance with applicable state and federal laws.
• Makes recommendations to management regarding service quality provided by TPAs, outside counsel, structured settlement vendors.
• Ensures settlements are consistent with Company guidelines, policy and procedure.
• Ensures claim documentation is accurate, organized and properly maintained.
• Submits thorough and accurate reports as necessary.
• Presents claim updates to the member with superior member service.

Requirements

• 6-10 years general liability claims experience directing serious bodily injury liability claims and litigation of significant exposure and complexity on a regional or national level.
• Strong knowledge of contract, tort, subrogation, contribution, indemnity and other related law.
• Able to effectively direct and control work of outside counsel and TPA.
• Superior verbal and written communication skills.
• Excellent evaluation and analytical skills, including ability to recognize new or changing information that could affect the claims handling strategy and/or potential claims cost.
• Able to interpret and apply applicable laws and regulations, determine the appropriate course of action and present solutions to resolve claims within multi-million-dollar retention.
• Knowledge of risk management information systems and statistical data.
• Able to articulate understanding of the impact that effective claims management has on the business.
• Scheduling flexibility to meet the needs of the business; available for occasional travel.

Qualifications

• High School Diploma or GED.
• Bachelor’s Degree preferred.
• Senior Claims Law course work or other industry training/designations.
• Ability to assess actual damages associated with claims and conduct settlement negotiations within assigned authority limits.
• Ability to analyze legal documents and medical records.
• Extensive knowledge of litigation practices and procedures.

Skills

• Superior verbal and written communication skills.
• Excellent evaluation and analytical skills.
• Ability to assess actual damages associated with claims and conduct settlement negotiations within assigned authority limits.
• Ability to analyze legal documents and medical records.
• Extensive knowledge of litigation practices and procedures.

Benefits

• Paid time off
• Health benefits - medical/dental/vision/hearing aid/pharmacy/behavioral health/employee assistance
• Health care reimbursement account
• Dependent care assistance plan
• Short-term disability and long-term disability insurance
• AD&D insurance
• Life insurance
• 401(k)
• Stock purchase plan to eligible employees

Pay

$98,000 - $114,000

Schedule

Scheduling flexibility to meet the needs of the business; available for occasional travel.