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Years of Experience
Date Last Verified
ProfileClaims Specialist III, Property Large Loss RESPONSIBILITIES: Promptly and effectively handles to conclusion assigned claims with little to no direction and oversight which may include complex and catastrophic casualty losses. Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight. Makes decisions within delegated authority, recommends settlement values in the disposition of serious and sometimes complex claims as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service. Accurately pays claims based on policy provisions, state mandates and/or fee schedules. Determines proper policy coverages and applies best claims practices to conclude assigned cases in accordance with company guidelines. Adheres to high standards of professional conduct while providing delivery of superior claims service. Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. Maintains current knowledge of: court decisions which may impact the claims function; current principles and practices in the claims function; material damage techniques and repair technology innovations; and policy changes and modifications. May be required to maintain knowledge of other functions within assigned discipline. This may require attendance at various seminars or training sessions. Maintains current knowledge of local industry repair procedures and local market pricing. Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management. Creates ans analyzes severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting. Partners with SIU and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty). Manages or prepares files for suit, trial or subrogation. Consults claims staff and defense counsel for discovery processes, suit file/trial strategy as related to case-specific issues. Initiates and conducts follow-ups via proficient use of the claims systems and other related business systems. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective customers. Able to act for the Claims Manager; provides leadership to less experienced claims associates; provides one-on-one training. Other duties as assigned.
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' experience handling property claims, insurance processing or field claims adjusting. Proven knowledge of insurance theory and practices, insurance contracts and their application. Advanced knowledge of causality claims best practices, medical terminology and the legal aspects of court procedures affecting legal liability for all lines of insurance. Excellent customer focus and proven ability to proactively meet customer needs. Analytical skills necessary to make decisions and resolve conflict in application of coverage, laws of jurisdiction to investigation facts, policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for extensive 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 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 various audiences. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. 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.
Job ID: 48560