Complex Claims Specialist

Complex Claims Specialist

The primary role of a Complex Claims Specialist is to promptly and professionally ensure high quality claim handling by analyzing liability of claim submissions while making coverage determinations, investigating losses, conducting independent assessment as to the insured's exposure and moving cases towards timely resolution. You will be an effective source for help and support because of your deep knowledge and liability claim expertise.

Key Functions will include but not be limited to :

The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also :

• Adjusts and resolves complex to severe commercial claims that may also include all phases of litigation for our Bodily Injury team.
• Plans and conducts investigations of high severity claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate.
• Assesses policy coverage for submitted claims and notifies the insured of any issues.
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters.
• Determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
• Reviews and analyses claim documentation and legal filings.
• Assesses actual damages associated with claims and confidently conducts negotiation within assigned authority limits, to settle claims.
• Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company.
• Acts as senior technical professional on team, assisting team members with escalated issues.
• Develops and maintains excellent rapport with our agency force, insureds, claimants, experts, attorneys, and internal customers
• Attend mediations, trials, and overnight travel as needed.

Qualifications

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship Details

Sponsorship not Offered for this Role