Complex Claims Senior Resolution Specialist

Complex Claims Senior Resolution Specialist

Requirements

• Must have an expert knowledge of coverage, liability, and complex claims handling procedures.
• Must be able to effectively handle claims at the highest technical and complexity level.
• Must be knowledgeable of state and federal laws in the adjuster’s jurisdiction.
• A full working knowledge of claims operations and procedures is required.
• Excellent written and oral communications skills required as well as strong interpersonal, analytical, investigative and negotiation skills.
• The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and at least 7 years of directly related experience.
• Ability to obtain proper licensing as required.

Responsibilities

• Manages, investigates, and resolves auto and homeowner’s casualty claims.
• Investigates and evaluates coverage, liability, damages, and settles claims within prescribed procedures and authority.
• Recommends ultimate resolution on assigned cases in excess of their authority to local claims management and Home Office.
• Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
• Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status.
• Confers with trial counsel and prepares trial reports.
• Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action.
• Responds to various written and telephone inquiries including status reports.
• Ensures adequacy of reserves. Recommends reserve increases on cases in excess of authority.
• Accountable for security of financial processing of claims, as well as security information contained in claims files.
• Responsible for managing the practices and billing activities of outside and in-house counsel.
• May assist in the absence of the Claims Team Manager, representing the company on matters involving state or federal regulatory agencies.
• May be involved in special projects and/or mentoring at the direction of local management.

Preferred Qualifications

• 5+ years of litigation experience
• Expert knowledge of handling personal lines complex claims with severe to catastrophic injuries and fatalities