Support PDF,DOC,DOCX,TXT,XLS,WPD,HTM,HTML fils up to 5MB
PIP Litigation Claims Specialist Duties: Responsible for handling secondary or transferred claims on high exposure and/or complex losses in which initial work was completed by other claims representative. Review claim for accuracy and completion with regard to investigation into facts of loss, coverage and liability, settlement value, settlement options and plan of action recommended from reassigning party. Assist in training, developing and mentoring of Claim Representatives, along with acting as subject matter expert in the handling of complex and/or legal claim issues. Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. Review claims for accuracy and completion with regard to investigation into facts of loss, coverage and liability, settlement value, settlement options and plan of action recommended from reassigning party; determine if additional investigation, medical documentation or work is needed; determine settlement value and settlement options and negotiate injury claims of a serious and complex nature within authority granted Establish liability investigation plan with telephone claims representative on initial losses received; when needed, assist in the investigation by gathering facts and evidence with all witnesses and interested parties, take recorded statements, analyze extent of property damage and review loss reserves, adjusts and/or opens hidden exposures. Determine if potential subrogation or fraud issues exist and refer to appropriate claim unit for handling, with recommendation on plan of action, or may independently determine to handle issues to conclusion. Gather, analyze and evaluate for settlement purposes all supportive medical documentation which may include obtaining medical authorizations, medical and lost wage records. Handle claims in litigation which includes demonstrating knowledge of the litigation process, knowledge of applicable National General litigation policies and procedures and interpreting and applying this knowledge to claims in litigation; determine whether to negotiate settlements directly with plaintiff counsel or refer to defense counsel; manage litigation and recovery costs; utilize ADR when appropriate. Assist in training, developing and mentoring of Claim Representatives as needed. Act as subject matter expert in regard to complex and/or legal claim handling issues. Prepare for and attend legal case mediation and settlement conferences as necessary. Assist with file audits, research projects and other assignments as needed. Assist management with organizing, facilitating and participating in file roundtables as needed. Assume leadership role in the absence of management.
Qualification and Experience
Qualifications: Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience. Completion of one or more professional designations: AEI’s Legal Principals or completion of the Associate in Claims designation (AIC 33, 34, 35, 36), CPCU, SCLA (Senior Claims Law Associate), FCLS (Fraud), PCLS (Property), CCLS (Casualty), LPCS (Legal Principles) and JD Degree. Obtain/Maintain appropriate licensing or education requirements. Ability to work independently with minimal to no supervision on complex and litigated files. Demonstrate strong understanding in file audits to agreed standard of efficient claims quality. Demonstrate a solid command of the claims policies and procedures, in addition to, the interpretation of policies and procedures in resolving claims. Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan. Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures. For claims involving injuries, has solid understanding of how to review, evaluate and negotiate injury claims. Desired: Possess a thorough command, understanding and knowledge of state laws, regulations and NGI Claims Handling Guidelines applicable to claims handled, including state unfair claim practice laws. Demonstrate ability to handle litigation in accordance with company guidelines and be able to recognize legal issues; ability to utilize ADR when appropriate. A high degree of initiative, independent judgment and discretion. Ability to resolve conflicts and empathize with customers. Negotiation skills to use in resolving claims. Professional verbal and written communication skills. Solid skills in organization and time management. Expertise in insurance law and able to interpret and apply these laws as it relates to claims. Demonstrate a proficient application of the insurance industry and organizational relationships of the company; demonstrate an understanding of the functions of other departments such as Policy Ops and Marketing. Possess effective leadership and mentoring skills.
Company infoHiring Coordinator