Senior Claims Specialist - Casualty

Under minimal to no supervision, handles claims from first notice to final disposition. Duties include, but are not limited to, coverage analysis, investigation, litigation management, and negotiation of a variety of claims assigned, including the more complex and severe damage and/or injury cases.

• Receive claim loss information from agencies, insured, and claimants or other involved parties via telephone, facsimile, mail, or computer; and establish a claim on the appropriate computer claim handling system.
• Review limited assignments as well as assigned claims for applicable coverage, liability, and exposures.
• Handle those losses or litigated claims involving the greatest complexity.
• Must have thorough knowledge of all lines of business written by the company, including, but not limited to auto, homeowners, dwelling fire, commercial general liability, and umbrella.
• Review applicable policy forms, determine and explain available coverage/benefits, resolve conflicts.
• Contact insured and other involved parties within the specified time frame, as outlined by department procedure.
• Determine/confirm facts of loss/cause of loss, identify parties involved, and extent of injuries or damages, as applicable.
• Obtain written or recorded statement(s) as needed.
• Inspect, photograph, and diagram damages and the scene of loss. Ensure the investigation is thorough and complete, and documentation in the file supports the claim. Secure and preserve evidence.
• Obtain other documentation, as appropriate, including but not limited to police and fire investigative reports, applicable contracts, plans and specifications, diagrams and photographs, repair proposals and appraisals, and medical records and bills.
• Determine liability based on facts developed and thorough knowledge of the applicable Hawaii Revised Statutes and other applicable laws.
• Provide clear and concise analysis of liability based on the facts and the applicable Hawaii Revised Statutes and other applicable laws.
• Provide analysis of alleged damages and injuries.
• Initiate deductible recovery procedures where applicable.

• Review questionable claims and all coverage issues with the Claim Manager.
• Communicate status to insureds, claimants, and their attorneys, if any, as required by the Hawaii Revised Statutes or per department policy.
• Stay abreast of statute, case law decisions, as well as policy and coverage changes.
• Possess a positive, service-oriented attitude toward agencies, insureds, and employees within the company.
• Provide quality claims handling and superior customer service on a regular basis.
• Serve as a mentor to other claims professionals in a technical capacity.
• Assist other claim professionals with claims handling, evaluations, negotiations, and litigation issues.
• Provide technical advice/direction to department personnel on more complex claims.
• Assist with the assignment of claim assignments as needed, reviewing first notices of loss, providing direction, and support to the assigned individual.

• Perform appropriate and timely processing of financial transactions, including establishing reserves, adjusting reserves, and making payments on the applicable claim system, as authorized.
• Prepare and submit written requests for authority, as well as other reports, as required.
• Evaluate damages and injuries considering applicable coverage, liability determination, and other pertinent information developed.
• Negotiate settlements within authority granted.
• Enter timely, clear, and concise notes on the applicable computer claim handling system to document all activities – investigations, evaluations, recommendations, negotiations, and resolution.
• Diary all assigned claim files for timely follow-up and review them within the specified time frame as outlined by department procedure.
• Manage all outside vendors (e.g., independent adjusters, appraisers, contractors, investigators, experts, and attorneys) to minimize the length of time to resolution of the claim, and the allocated loss expenses.
• Follow prescribed litigation guidelines and procedures including reporting requirements and attorney fee review program.
• Attend and participate in mediations, arbitrations, settlement conferences as required.
• Perform accurate and timely preparation and submission of data and reports, as required by the department procedure or management.

• High school diploma or general education degree (GED); and 5-7 years multi-line Claims Specialist required.
• College degree with credits in insurance related subjects preferred.
• Equivalent combination of education and job-related experience will be considered.
• Continuing education in insurance and job related issues and subjects required.
• State of Hawaii general adjusting license preferred.
• Valid Hawaii Driver’s license and use of own vehicle required.
• Enrollment or completion of IIA, AIC or other insurance industry courses preferred.