Job Title: Senior Claims Specialist - Design Professional
Job Responsibilities:
- Direct management of claims, including investigation, analysis, and evaluation of coverage liability and damages, in alignment with best practices for third-party, rectification, and sub-gap claims.
- Review claims to determine the nature of loss, coverage provided, and scope of the claim to guide strategic direction regarding settlement and disposition of claims.
- Develop and maintain relationships with internal and external partners, acting as the lead contact within the claims department for assigned claims and the claims of direct reports.
- Collaborate closely with the Specialty Complex Claims team regarding coverage disputes, including litigation and arbitration matters involving company issuing companies.
- Collaborate across disciplines and business units, including the general counsel team overseeing errors and omissions issues arising from claims handling.
- Escalate coverage issues and recommend outside coverage counsel assignments for approval when warranted.
- Formulate claims and litigation strategies, assign, direct, and manage outside counsel.
- Manage costs, including the use of coverage counsel and litigation costs, and collaborate with the Litigation Management and Vendor Management teams to ensure cost management and enhance vendor panels.
- Foster relationships and communicate extensively with senior executives, brokers, reinsurers, actuaries, underwriters, insureds, and auditors (both external and internal).
- Support underwriting inquiries and information requests regarding policy construction and drafting, reporting claim trends, data analysis, and risk assessments.
- Maintain documentation of key line of business statistics and metrics.
- Lead and participate in presentations and discussions with Underwriters and Insureds on large losses and claim trends.
- Lead and participate in claim audits, audit wrap-up meetings, and formal result reporting.
- Identify liability and coverage trends and issues with both individual and portfolio impact, and formulate processes and strategies for handling such claims while ensuring consistent claims management across impacted underwriting segments and lines of business.
- Perform other duties as assigned.
Education and Experience Information:
- 5-10+ years of claims management experience in Casualty and/or Specialty Lines Claims.
- Demonstrated leadership, organizational, and management skills or experience practicing law as well as claims management (both directly managed and TPA managed claims).
- Demonstrated ability to influence and collaborate at all organizational levels, both internally and externally, and the ability to identify and resolve complex, disputed claims.
- Analytical thinker capable of driving results using all facets of the legal and claims processes.
- Understanding of and ability to balance both immediate claim issues and broader portfolio and customer service impacts of coverage disputes and issues.
- Excellent oral and written communication skills with the ability to deal effectively with people with conflicting expectations, differing opinions, and multiple viewpoints.
- Demonstrated ability and experience handling casualty claims involving a wide variety of loss scenarios and reporting and presenting about the same to senior management.
- In-depth knowledge of claims, litigation, arbitration, and trial processes, as well as excellent analytical, investigative, and negotiating skills.
- Bachelor’s degree required; JD is a plus.
- Technical knowledge, skills, and training within the field include:
- Complex coverage analysis and experience required.
- Confidence in coverage, evaluation, and reserving.
- Excellent writing and editing skills.
- Solid negotiation and settlement skills.
- Supervisory perspective, with experience providing direction and authority to adjusters.
- Familiarity with KPI, Data, and Metrics is a plus.
- Valid licenses by state as required, with the ability to add states to certifications as needed.
Salary Information:
- The anticipated base salary is between $160,000 and $180,000.
Additional Information:
- Travel is associated with this role, including team management, court proceedings, mediations, and settlements.
