Claim Specialist (340987)
The Claim Specialist, under moderate direction from the manager, investigates and settles claims promptly, equitably, and within established best practices guidelines.
- Responsible for investigating; settling high exposure, high risk Employment Practices Claims.
- Insure high level of customer service and claim file quality.
- Identifying and evaluating coverage issues, preparing comprehensive coverage letters and analysis, retaining and managing coverage counsel through trial, and developing and managing strategy for complex coverage litigation.
- Evaluating exposure through an in-depth analysis of legal and factual issues, retaining and managing litigation counsel through trial, developing and managing strategy for complex litigation.
- Attending arbitrations, mediations, trials.
- Developing resolution strategies and negotiating settlements.
- Reviewing legal budgets and legal and third-party vendor’s bills.
- Presenting litigation strategy for complex litigation to senior claims management and underwriting staff.
- Support business leaders on an as needed basis on various claim and underwriting related issues and marketing meetings.
Duties may include, but are not limited to:
- Day to day handling of substantial caseload of line of business claims.
- Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
- Analyzes coverage and communicates coverage positions, as warranted, under direction of supervisor and coverage unit.
- Conducts, coordinates, and directs investigation into loss facts and extent of third-party damages.
- Directs and monitors assignments to experts and underlying defense counsel.
- Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
- Sets reserves within authority or makes claim recommendations concerning reserve changes to supervisor.
- Reports to reinsurers and facilitates the prompt collection of reinsurance on those matters where they are accountable.