Claim Representative II - Casualty

General Liability Claims Technical Specialist

Directly handle a technical claims caseload of a general liability claims. Caseload typically comprised of files arising from a broad range of coverage or perils and possessing a wide range of financial exposure and complexity. Such claims occasionally involve coverage issues or litigation. Employee should possess demonstrated expertise in handling bodily injury claims which involve both comparative negligence theories and defenses and be able to conclude claims promptly and equitably within the provisions of the policy contract and in accordance with known damages and legal requirements. Litigated files should constitute a minority of pending. All files handled must comply with claim file handling guidelines and all other job expectations, regulations and requirements.

Duties and Responsibilities :

• Conduct and coordinate loss investigations on all assigned claims.
• Negotiate the settlement of claims within authorized amounts or specific file authority.
• Maintain accountability for all assigned claims until disposition is reached.
• Recommend further action to supervisor on claims exceeding authority limits.
• Document all substantive activity on assigned claims and assist in the control of independent vendors.
• Review new losses and open files on diary to ensure reserve adequacy while keeping management informed of adverse developments.
• Monitor loss adjustment expense and take steps to mitigate file expenses.
• Utilize vendors judiciously to maximize value added.
• Recognize coverage issues and work with supervisor and claim management for manner of redress / resolution.
• Refer appropriate coverage matters to the Claim Supervisor or Claim Manager.
• Ensure appropriate file handling, documentation, reporting and expense control of all files handled inclusive of legal bill review / vendor performance / bill review / MSP compliance.
• Provide accurate, courteous and timely information to all eligible external and internal customers concerning claim status and other claim inquiries.
• Attend meetings with policyholders and agencies as needed.
• Draft coverage correspondence in collaboration with Supervisor, including reservation of rights and coverage disclaimer along with composing detailed correspondence to insureds, claimants, attorneys, etc.
• Attend trials, depositions, EUOs, appraisals and mediations where deemed beneficial or required.
• Participate in various forms of litigation training and as a mentee with an assigned Examiner Mentor for litigation and coverage advancement.
• Improve processes within the department to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, systems implementation, etc.
• Participate in setting file direction and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting to management.
• This position handles an assigned claim pending.
• Performs other duties or special projects as required or as assigned.

Supervision Received : The Claim Supervisor provides direct minimal supervision.

Supervision Exercised : Primarily no supervisory duties; however limited supervision of independent adjusters and vendors may occur.

Qualifications :