Senior Casualty Claims Representative

Responsibilities

• Investigate, evaluate and resolve assigned claims in accordance with company standards, procedures, and state regulatory requirements.
• Perform investigations in a timely and thorough manner to ensure accurate decisions on coverage, compensability, liability, and damage issues affecting claim resolutions.
• Effectively negotiate with insureds, third-parties and claimants listening carefully to their demands and using an objective approach to resolve the claim fairly.
• Control file-related expenses through efficient utilization and monitoring of "outside" vendors.
• Inform other departments of positive/negative conditions noted during investigations which may impact company results.
• Manage existing workloads effectively to achieve quality and quantity production goals while providing superior customer service.
• Participate in special account reviews and present agents and insureds with recommendations for improving their loss ratio and information on best practices.
• Steadily increase complexity and proficiency including more complex coverage and/or compensability disputes, contractual risk transfer, liability/subrogation investigations, negotiations, and strategic resolution practices.
• Engage appropriately with agents and insureds in increasingly complex discussions and capable of leading synergy meetings.
• Assist in the training and development of claim personnel as needed.
• Under general direction, handles complex cases and those involving complex questions of coverage, compensability, legal liability and damages.
• Handles complex bodily injury, property damage and workers’ compensations cases utilizing experts and outside firms as required.
• Works closely with underwriting in developing and interpreting policy language and, in conjunction with loss control, assists in the analysis and recommendations on loss sensitive and special accounts.
• May serve as team leader or mentor in the training and development of less experienced staff and provides input in roundtable discussions.
• Attends settlement conferences, trials and mediations on a regular basis.
• Demonstrate professionalism and promote Acadia's values and presence as a Trusted Advisor internally and externally.
• Have a strong understanding of the business of insurance outside of the claims discipline.
• Significant independence in claims handling of the most complex claims not requiring major case unit/specialty handling.
• Effectively mentor staff including providing direction for claims handling strategies within their authority.
• Exhibit initiative, a team minded attitude, be proactive in anticipating areas of concern.

Qualifications

• Bachelor's degree (B. A.) and minimum of 5-7 years of related experience and/or training; or equivalent combination of education and experience.
• Minimum of 5-7 years of progressive property & casualty and/or workers' compensation claims handling experience, including complex liability and coverage investigations.
• Demonstrated expertise in investigating, analyzing, and resolving complex claims involving coverage disputes, compensability issues, legal liability, bodily injury, property damage, and workers' compensation exposures.
• Strong knowledge of insurance policies, contract interpretation, contractual risk transfer, subrogation, litigation management, and claim resolution strategies.
• Prominent ability to negotiate effectively with claimants, attorneys, insureds, agents, and third parties to achieve fair and cost-effective settlements.
• Experience managing litigation, including attending mediations, settlement conferences, arbitrations, and trials, and coordinating with defense counsel and expert witnesses.
• Thorough understanding of insurance regulations, state statutes, claims best practices, and industry standards.
• Ability to evaluate damages, reserves, settlement values, and claim exposures while maintaining authority limits and company guidelines.
• Experience utilizing independent adjusters, investigators, medical providers, attorneys, engineers, and other vendors to support claim investigations and control expenses.
• Strong analytical and critical thinking skills with the ability to make sound decisions on complex and high-exposure claims.
• Demonstrated ability to manage a large and diverse caseload while achieving quality, productivity, and customer service objectives.
• Excellent written and verbal communication skills with the ability to present recommendations and build credibility with insureds, agents, attorneys, and internal business partners.
• Proven ability to collaborate effectively with underwriting, loss control, legal, and other departments to identify trends and improve business outcomes.
• Strong leadership, mentoring, coaching, and training skills with experience supporting the development of less experienced claims professionals.
• Ability to facilitate roundtable discussions, lead claim strategy meetings, and contribute to organizational initiatives and special projects.
• Advanced proficiency with claims management systems, Microsoft Office applications, and other insurance technology platforms.
• Demonstrated ability to work independently, exercise sound judgment, and manage highly complex claims with minimal supervision.
• Strong business acumen with a broad understanding of insurance operations, underwriting principles, loss control practices, and agency relationships.
• Professional designations such as CPCU, AIC, ARM, SCLA preferred.
• Relevant state adjuster license(s) required.
• Proven record of professionalism, integrity, initiative, and commitment to delivering trusted advisor-level service to internal and external stakeholders.
• Ability to identify emerging risks, anticipate issues, and proactively develop claim handling and resolution strategies while fostering a collaborative, team-oriented work environment.