Claims Advocate – Specialty Insurance

Claims Advocate – Specialty Insurance

Requirements

• 7-10 years related experience and/or training; or equivalent combination of education and experience.
• Prior experience managing direct reports.
• Conflict resolution skills and thorough understanding of company policy and procedures.

Responsibilities

• Conduct Monthly Dashboard Analysis
• Lead monthly update meeting with TPA, Carrier, Wholesaler, MGA, Etc.
• Create and/or refine Best Practices for assigned TPA or Carrier
• Conduct quarterly leakage audit in conjunction with carrier and or TPA
• Keep key stakeholders informed of significant activities
• Participate in large, complex claims and coverage issues
• Complete a monthly activity report for Division heads
• Conduct relevant training to improve process and technical skills
• Participate in the implementation of AI, automation, and machine learning
• Review all coverage denials
• Receive and review all ROR and Denials
• Review And Push Carrier for Subrogation and SIU Concerns
• Provide Executive Summary of Loss Reserves or Payment $100K+ Cause, Subro Potential, Coverage Confirmation, Stewardship/Follow Up Gameplan, Interact and advocate for VIP clients and key stakeholders.

Preferred Qualifications

• CPCU, AIC, ARM or SCLA Designation
• Graduate Degree