Complex Claims Specialist (Professional Lines)

Job Summary

Looking for a highly skilled and experienced Complex Claims Specialist to join a growing team. This role involves managing complex and severe claims, including all phases of litigation, and providing operational support to the claims team. The successful candidate will play a pivotal role in driving litigation best practices, mentoring claims examiners, and ensuring positive claim outcomes through investigation, negotiation, and alternative dispute resolution.

Compensation Package

• Salary Range: $100,000 - $155,000/year
• Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

• Adjust and resolve complex to severe claims, including all phases of litigation.
• Draft complex coverage letters, including reservation of rights and denial letters, with minimal supervision.
• Review and analyze claim documentation and legal filings.
• Drive litigation best practices to lead defense strategies on litigated files.
• Mentor and train Claims Examiners.
• Investigate, negotiate, and utilize alternative dispute resolutions to achieve positive claim outcomes.
• Identify emerging exposures and claims trends.
• Detect and track suspected fraudulent claims in collaboration with the special investigations unit.
• Accurately document claim files in compliance with company policies and regulatory requirements.
• Develop and deliver training content for claims teams and underwriters.

Qualifications/Requirements

• Experience:
  • 8+ years of claims handling experience or 7-8 years of litigation experience.
  • Proven ability to positively affect complex claims outcomes through investigation, negotiation, and litigation leadership.
  • Advanced knowledge of claims analysis, adjusting practices, and litigation processes.
• Education:
  • B.A./B.S. degree from an accredited college or university preferred.
  • A JD from an ABA-accredited law school may be considered as a supplement to claims handling experience.
• Skills:
  • Advanced analytical, negotiation, and communication skills.
  • Experience mentoring and training other claims examiners.
  • Ability to act as a subject matter expert within the team.
  • Demonstrated ability to work with minimal oversight and lead mediations, arbitrations, and trials.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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