Description
The Senior Technical Claims Specialist determines coverage, investigates complex and highly complex Commercial Casualty claims, determines liability, sets and adjusts reserves, evaluates the claim, negotiates a settlement, authorizes and resolves the claim. In this role, you will demonstrate a high level of expertise and sound judgment in complex matters; may act as a subject matter expert.
You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Weatogue, CT. Please note this policy is subject to change.
Responsibilities:
As the claim’s owner, determines coverage, investigates the claims, determines liability, sets and adjusts reserves, evaluates the claim, negotiates a settlement, authorizes and pays the claim; may deny claims.
Reviews lawsuit documentation and supporting documents, claims file, investigation, etc. Establish actions to be taken to resolve lawsuit.
Includes determining loss coverage, amounts owed, discovery plans, setting reserves and negotiations.
Establishes appropriate working team (Home Office Legal, Defense Counsel and Home Office Claims) based on allegations established in suit.
Responsible for managing the practices and billing activities of outside counsel.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Trains and mentors staff as appropriate; manages relationships and acts as liaison with various business partners (e.g., Underwriting, Reinsurance, Etc.).
Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to specialty coverage issues.
May analyze the impact upon claims policies and procedures and advises Claims.
Management so appropriate action can be taken where required.
Participates in special projects.
Qualifications
Bachelor’s degree and 5 to 7 years claims adjusting experience.
Advanced knowledge of Commercial Casualty claims investigation, coverage evaluation, reserving & expense management, resolution strategy, negotiation, litigation management, claims evaluation as well as the insurance legal and regulatory environment required.
Intermediate to advanced level of skill in the area of customer focus, problem solving, communications, gaining support, teamwork, and adaptability and demonstrated ability to work independently, achieve results and execute thoroughly.
Complex Commercial Claims, Shared Economy, significant client involvement and/or interaction experience required.
Employees may apply for a new role after completing 12 months of employment in their current position.