Insurance Attorney in Scottsdale, AZ

Profile

Specialist III, Claims QA CL Duties: Conducts commercial and/or workers compensation claims and/or Excess & Surplus (E&S) technical file reviews and/or re-inspections, calibration and audits. Serves as a technical resource and expert in the review and evaluation of commercial and/or workers compensation claims files in accordance with established policies and procedures. Provides specialized commercial and/or workers compensation claims training in accordance with ongoing training and developmental needs. Performs quality re-reviews and calibration functions to ensure file adequacy and the measurement of loss cost opportunities in accordance with and support of best claim practices and On Your Side Service. May provide commercial technical and training support to claims operations, assisting in identifying performance trends and in implementing performance improvement initiatives. May advise claims leadership on technical trends based on objective findings. Conducts quality audits to assess claim handling in accordance with policy terms and claim best practices. Ensures the audit file decisions are made within delegated authority and settlement values are recommended in the disposition of claims as outlined in company policies and procedures. Ensures adherence to high standards of professional conduct consistent with the delivery of superior service. Conducts closed and/or open file audit reviews and re-inspections for the purpose of compiling skill adequacy and lost cost opportunity results. May identify and communicate trends for claims managers and leaders. Audits claims file to ensure proper reserve analysis to validate the accuracy and timeliness of case reserves in accordance with best claims practices. Recommends reserves where necessary. Maintains current knowledge of: assigned insurance lines; court decisions that may affect the claims function; current guidelines, principles and practices in the claims function; and commercial and/or workers compensation policy changes and modifications. Maintains knowledge of material damage/property damage techniques and repair technology innovations. May be required to maintain knowledge of other functions within assigned discipline. Completes calibration reviews and works with claims managers to calibrate on accurate application of best claims practices. Serves as a mentor to less experienced claims associates and assists with training/presentations as needed. Provides technical file review training and support to other review associates as assigned. Acts as a technical resource by providing input and support to claims leadership regarding claims performance and utilization of the quality audit process. May audit claims file to ensure the creation and analysis of severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting. Maintains a high level of calibration proficiency in team/review calibration exercises. Audits claims files to ensure partnership with SIU and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for suit, trial, or subrogation. May audit litigation files to ensure proper litigation strategy is related to case-specific issues. Delivers a positive On-Your-Side customer service experience to internal, external, current and prospective customers.

Qualification and Experience

REQUIREMENTS: Undergraduate degree or equivalent experience preferred. Advanced degrees in law or related discipline desired. Successful completion of required claims certification schools/courses. Professional development such as IIA or CPCU preferred. State licensing where required. 5 years of commercial and/or E&S claims experience in progressively more technical/complex claims positions. Experienced in use of computer based estimating software and experience interpreting estimates using unit pricing. Knowledge: Requires advanced knowledge of claims best practices, technical claims operations, procedures and claims performance strategies, day-to-day claims operations, claims operating practices, and claims litigation laws and regulations. Requires in-depth knowledge of Nationwide's commercial and E&S product offerings, underwriting practices, and pricing strategies. Commercial and/or E&S policy knowledge/analysis required. Proven knowledge of insurance theory and practices, insurance contracts and their application. Advanced knowledge of casualty claims best practices, medical terminology and the legal aspects of court procedures affecting legal liability for all lines of insurance. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Proven analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to establish repair requirements and cost estimates for extensive material damage losses and serves as a subject matter expert on respective claims projects. Proven organizational skills to effectively prioritize increased and more complex workloads. Demonstrates strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, repair persons, attorneys, agents, and general public. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. Proven ability to operate personal computer with proficient use of claims and business software.

Additional info

Job ID: 39974

Company info