Claims Specialist

About the Role

As a Claims Specialist, you will be deemed a subject matter expert in the Claims department. Your extensive experience in commercial claims will allow you to handle high-severity and high-complexity claims. You will also lead department roundtables and have the opportunity to serve as a valuable peer resource to other team members.

What You'll Do

• Extensive policy document and legal contract interpretation
• Ability to analyze and identify coverage and related coverage issues
• Leverage a working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims
• Manage, investigate, and resolve claims within prescribed authority levels
• Recommend ultimate resolution on assigned cases in excess of authority to claims management
• Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims
• Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues
• Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action
• Preemptively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status reports
• Present file materials for authority and roundtables
• Work with nurses, doctors, and attorneys on file reviews
• Comply with all statutory and regulatory requirements of all applicable jurisdiction
• Meet detailed quality assurance standards and meet set goals for performance
• Set and revise case reserves in accordance with the reserving policy
• Identify potentially suspicious claims and refer to SIU; identify opportunities for third-party subrogation
• Be accountable for the security of the financial processing of claims, as well as security information contained in claims files
• Work with, and provide claim-specific guidance to, independent field adjusters
• Partner closely with internal teams and advise leadership of key claim activities and exposures

What We Need

• BS/BA Degree required
• Advanced studies or insurance designation preferred
• At least 15+ years of directly related experience with Commercial General Liability and Litigation
• Strong written and oral communication skills required, as well as strong interpersonal, analytical, investigative, and negotiation skills
• In-depth knowledge of multi-jurisdictional claims handling issues
• Willingness to utilize and adapt to evolving technologies within the Claims operations
• Must be a self-starter and able to work independently
• Candidates must have, or be able to promptly obtain, a Texas Independent Adjuster License
• Effective communication, presentation, negotiation, and persuasion skills