Support PDF,DOC,DOCX,TXT,XLS,WPD,HTM,HTML fils up to 5MB
Years of Experience
Date Last Verified
ProfileESIS - ProClaim Claim Director The candidate will be responsible for investigating; settling high exposure, high risk claims. Insure high level of customer service and claim file quality. Will 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. Travels to conferences, mediations, and trials as necessary. Under close supervision, receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business. Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, healthcare providers, attorneys, police officers, etc. to secure necessary claim information. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Sets reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. Working closely with defense counsel, manages litigation proactively. Settles claims promptly and equitably. Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims. Informs claimants, insureds/customers or plaintiff attorney of denial of claim when applicable. Ability to work at the client’s location or designated approved remote office.
Qualification and Experience
The candidate must have 5+ years of General Liability, Products and Automobile claim handling experience. Should have College degree or equivalent business experience. Excellent interpersonal communications and negotiation skills is required. Authoritative knowledge of the company’s coverage, products, services, and liabilities is required. Excellent verbal and written communication skills is required. Should have high degree of specialized and technical competence in the handling of high exposure claims with emphasis on hands-on file management. Experience with International Claims preferred. Should have Bachelor’s degree in Business Administration or associated field. Must have multiply jurisdictional claims handling experience. IEA certification is required. Self Insured Certificate is required. 10+ years of experience as a claims professional with a high degree of specialized and technical competence in the handling of high exposure claims with emphasis on hands-on file and litigation management is desired. P&C insurance adjuster license is desired. J.D. Degree or CPCU designation a plus. Complex Casualty Claims and General Liability (GL) with experience in Toxic Tort and Environmental claims is desired. Knowledge of insurance industry and claims handling concepts, practices, and procedures is desired. Strong background and demonstrated ability in dealing with significant coverage matters is desired. Knowledge of P&C Group coverage and services is desired. Working knowledge of industry best practices and procedures is desired.
Job Number: 315829