Claims Specialist , II, Sr

JOB SUMMARY/PURPOSE

Investigates, evaluates and resolves Liability claims in assigned geographical jurisdictions, while interacting daily with internal and external stakeholders in order to thoroughly and fairly resolve claims.

• Handles claims in assigned territories from start to finish, including thorough liability investigations and resolutions based on sound claims adjusting best practices and company guidelines. Oversees the activities of contracted vendors when utilized.
• Interacts with field employees and customer service functions, answering questions, explaining liability and other technical issues, while informing Claims hierarchy of all claim-related circumstances (i.e.: customer complaints, regulatory/executive complaints, etc.) requiring Management intervention/response.
• Ensures completion of thorough internal claim-status communications to management/leadership and other departments as appropriate.
• Ensures thorough claim-status communications when appropriate to Legal, Risk Management, excess insurance broker/carriers, etc., including timely issuance of reports when appropriate.
• Follows protocols in establishing reserves/receivables and securing settlement authority per guidelines. Ensures all claims are properly documented and assertively handled. Ensure all claims are properly reserved for anticipated liabilities or recoveries, reviewing reserve adequacy at least once per month, and properly requesting authority to adjust large reserves.
• Ensures that all claims are properly coded in the claims database with respect to workgroup, cause of incident, charging of payments/recoveries, etc. Ensure thorough running notes and formal reporting is maintained in all claim files per requirements.
• Identifies opportunities for process improvements and spend/cost reductions, often participating on related teams.
• Participates in Safety training/reporting programs, storm response teams and in acts of volunteerism.

Bachelor's degree, generally in Liberal Arts, Business, Insurance or Health Administration. Master’s degree a plus.

Customer Service Spec I: 3-5 years of liability claims adjusting experience with property & casualty insurer, third-party administrator or self-insured employer group.

Customer Service Spec II: 5+ years of liability claims adjusting experience with property & casualty insurer, third-party administrator or self-insured employer group.

Customer Service Spec Sr: 10+ years of liability and/or subrogation claims adjusting experience with property & casualty insurer, third-party administrator or self-insured employer group.

• Commitment to Safety.
• Ability to explain the processes of investigating, evaluating, negotiating, resolving, documenting and reporting-on complex claims. Understanding elements of compensability, legal liability, fact-finding/discovery and methods for claim adjudication. Ability to communicate with all levels throughout an organization, resolve conflict, accept push-back and criticism, understand “economic” decision-making, prioritize work, operate standard computer applications, successfully answer required behavior-based questions.
• Understanding elements of legal liability, fact-finding/discovery and methods for claim resolution/adjudication.
• Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements.
• Solves complex problems; takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information.
• Impacts a range of customers, operational, project or service activities within own team and other related teams; works within broad guidelines and policies.
• Ability to explain difficult or sensitive information; works to build consensus.
• Ability to prioritize and organize work.
• Ability to work independently in a fast‑paced environment with diverse internal/external stakeholders.
• Ability to operate computer applications, such as Word, Excel, PowerPoint and claims database.