Claims Specialist - Executive Claims Specialist - Allied Health Claims

Come grow with James River Insurance!

James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.

At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles : Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of being recognized the past 5 years as one of The Top Workplaces USA.

James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments : Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.

Job Summary

Under minimal supervision, the Claims Specialist / Executive Claims Specialist manages a caseload of high complexity commercial insurance claims focused on Allied Health (assisted living and skilled nursing facilities). The Claims Specialist will review claims to analyze land determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Perform coverage, liability, and damage analysis on all claims assignments
• Investigate allegations, determine facts based on evidence and interviews
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to independent licensed professionals
• Manage a caseload of high complexity claims with delegated authority
• Manage litigated files
• Negotiate settlements, mitigate losses, and control expenses
• Participate in and attend mediations to facilitate settlements
• Maintain accurate documentation in claim files
• Maintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokers
• Act as a consultant providing technical expertise within specialty area to internal stakeholders
• Provide technical guidance, assistance and training as needed for less experienced Claims professionals
• Maintain a passing quality assurance score on all audits and QAs
• Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
• Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
• Handle claims in accordance with established James River Claims Best Practices
• Other duties as required by management

Knowledge, Skills and Abilities

Experience and Education

Claims Specialist

Executive Claims Specialist

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Please note that this position is not eligible for H-1B visa sponsorship. All applicants must be currently authorized to work in the United States on a full-time basis without the need for current or future H-1B sponsorship.