Senior Claims Specialist, Specialty

Description

Under moderate direction, handles a book of specialty lines claims, throughout the entire claim's life cycle. Responsible for conducting investigations, recommending adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business.

Responsibilities

Analyzes, investigates, and evaluates the loss to determine coverage and claim disposition. Utilizes CMS to document claims and to diary future events or follow-up. Within prescribed settlement authority for the line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level. Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting. Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. Monitors the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority. Participates in Claims audit process. May provide claims marketing services by participating in meetings with brokers, risk managers and reinsurers. As required, maintains insurance adjuster licenses.

Qualifications

• Bachelors' and/or advanced degree
• 5+ years claims/legal experience; or in a related field
• Functional knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge
• Functional knowledge of law and insurance regulations in various jurisdictions
• Demonstrated strong verbal and written communications skills
• Demonstrated strong negotiation skills

• California
• Los Angeles Incorporated
• Los Angeles Unincorporated
• Philadelphia
• San Francisco