Liability Major Case Specialist New York City, NY

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Salary Range
$104000.00 - $171700.00
Target Openings
1
What Is the Opportunity
Under general supervision this position is responsible for investigating evaluating reserving negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts coverage investigation evaluation reserving litigation management negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals business partners customers and other stakeholders as appropriate or required. This position does not manage staff.

This role is eligible for a sign on bonus.
What Will You Do
Directly handle assigned severe claims.
Full damage value for average claim (without regard to coverage or liability defenses): $500000 to several million dollars amounting to a typical inventory of claims with FDV of over a multi-million dollar value.
Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Work with Manager on use of Claim Coverage Counsel as needed.
Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders accounts claimants law enforcement agencies witnesses agents medical providers and technical experts to determine the extent of liability damages and contribution potential.
Interview witnesses and stakeholders; take necessary statements as strategically appropriate.
Complete outside investigation as needed per case specifics.
Actively engage in the identification selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims such as Subrogation Risk Control nurse consultants nurse consultants and fire or fraud investigators and other experts.
Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Maintain claim files and document claim file activities in accordance with established procedures.
Develop and employ creative resolution strategies.
Responsible for prompt and proper disposition of all claims within delegated authority.
Negotiate disposition of claims with insureds and claimants or their legal representatives.
Recognize and implement alternate means of resolution.
Manages litigated claims. Develop litigation plan with staff or panel counsel including discovery and legal expenses to assure effective resolution and to satisfy customers.
Utilize evaluation documentation tools in accordance with department guidelines.
Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis.
Utilize diary management system to ensure that all claims are handled timely. At required time intervals evaluate liability and damages exposure.
Establish and maintain proper indemnity and expense reserves.
Provide guidance to underwriting business partners with respect to accuracy and adequacy of and potential future changes to loss reserves on assigned claims.
Recommend appropriate cases for discussion at roundtable.
Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
Apply the Companys claim quality management protocols and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance.
Apply litigation management through the selection of counsel evaluation.
Perform other duties as assigned.

What Will Our Ideal Candidate Have
Bachelors Degree.
10 years claim handling experience with 5-7 years experience handling serious injury and complex liability claims.
Extensive working level knowledge and skill in various business line products.
Excellent negotiation and customer service skills.
Advanced skills in coverage liability and damages analysis with expert understanding of the litigation process in both state and federal courts including relevant case and statutory law and procedure; expert litigation management skills.
Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims.
Able to make independent decisions on most assigned cases without involvement of supervisor.
Openness to the ideas and expertise of others and actively solicits input and shares ideas.
Thorough understanding of commercial lines products policy language exclusions ISO forms and effective claims handling practices.
Demonstrated strong coaching influence and persuasion skills.
Advanced written and verbal communication skills are required so as to understand synthesize interpret and convey in a simplified manner complex data and information to audiences with varying levels of expertise.
Can adapt to and support cultural change.
Strong technology aptitude; ability to use business technology tools to effectively research track and communicate information.
Analytical Thinking - Advanced.
Judgment/Decision Making - Advanced.
Communication - Advanced.
Negotiation - Advanced.
Insurance Contract Knowledge - Advanced.
Principles of Investigation - Advanced.
Value Determination - Advanced.
Settlement Techniques - Advanced.
Litigation Management - Advanced.
Medical Terminology and Procedural Knowledge - Advanced.
What is a Must Have
Four years bodily injury litigation claim handling experience or comparable claim litigation experience.

Required Experience:

IC

Employment Type : Full Time
Experience: years
Vacancy: 1
Monthly Salary Salary: 104000 - 171700