[Hiring] Senior Complex Claims Specialist @EMC Insurance Companies

Role Description

Directly handles the company's most complex casualty claims and litigated claims on a nationwide basis. Models best claims handling practices with an emphasis on the strategic handling and resolution of these complex claims. Delivers timely, expert support to the regional casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves.

• Directly handles the company's most complex claims and litigated claims involving serious injuries and highly sensitive/high profile cases.
• Proactively handles assigned claims to conclusion while modeling best claims handling practices, managing expenses, and pursuing early resolution when appropriate to positively impact indemnity outcomes.
• Serves as the subject matter expert on highly complex coverage issues impacting assigned claims, seeks assistance when needed or appropriate, issues coverage correspondence, and takes coverage into account when setting reserves and driving claims towards resolution.
• Sets timely, accurate, and well-documented reserves with proper communication to the agent, Branch VPs, and claims leadership while taking exposure, liability, allocation, and coverage into account.
• Conducts timely, thorough investigations into coverage, liability and damages while identifying, utilizing, and managing appropriate vendors based on need, expertise, expense, and geographic considerations.
• Prepares timely, concise, claim evaluations and file reviews.
• Develops, documents, and executes negotiation plans.
• Maintains timely and appropriate diary on all claims for optimum case control, exposure evaluation, expense management, and progress towards resolution.
• Composes concise claim notes, attaching documents when appropriate and using proper claim note categories and document titles.
• Collaborates with defense counsel to develop strategic defense and resolution strategies with action plans, appropriate budgets and invoice reviews.
• Presents claims in Claim Committee and Complex Roundtables and facilitates claim file discussions, and engages in Committee discussion to share technical claim handling and resolution expertise.
• Attends all mediations and trials, as necessary.
• Provides expert guidance to General Casualty, Complex, and/or Specialty Teams, including on serious injury claims.
• Reviews and communicates comprehensive evaluations of assigned claims presenting serious injuries (such as fatality, amputation, loss of sight, burns, paraplegia, quadriplegia, sex abuse, etc.), intellectual property claims, and claims with exposures of $750,000 or greater.
• Provides timely communication and assistance to various claims adjusters, managers, directors and/or claims leadership on issues requiring special attention.
• Provides follow up reviews when appropriate.
• Contributes to ongoing regional needs assessment analysis with insights gathered during Casualty collaboration process.
• Promotes and supports improved technical claims handling across claims teams in accordance with Best Practices.
• Identifies, recommends, develops, and delivers new training programs based on identified needs, opportunities, and industry trends, in collaboration with Learning and Development and claims leadership.
• Prepares engaging presentation materials and provides significant contributions as a leader and/or facilitating member during trainings.
• Identifies regional claims team members as potential candidates for the Complex Casualty Claims team.
• Actively participates in special projects to build company claims handling expertise and promote improved claim outcomes.
• Delivers exceptional customer service to General Casualty, Complex and/or Specialty Teams, insureds, agents, and internal customers.
• Delivers timely, expert support to the Casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves.
• Provides insureds and agents with concise, accurate status of claim activity and explanations of coverage, claim value and settlements.
• Promptly and appropriately responds to regional claim teams, insureds, agents, and internal customers.
• Serves as a technical subject matter consultant for regional team members and makes recommendations to Claims Consultant, Manager and/or Director for technical claims handling growth.

Qualifications

• Bachelor’s degree, preferably in business, economics, or related field, or equivalent related experience.
• Ten years of experience in complex claims handling or claims litigation, or relevant experience, including at least three years of claims litigation experience.
• Insurance designations such as AIC, CPCU, and/or other insurance education preferred.

Requirements

• Exceptional knowledge of litigation management, coverage, and technical file handling.
• Strong knowledge of the theory and practice of the claims function.
• Strong ability to evaluate legal liability, damages, coverages, and exposure.
• Excellent knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all commercial lines of insurance.
• Excellent leadership, collaboration, and negotiation skills.
• Excellent knowledge of computers and claims systems.
• Strong organizational, written and verbal communication skills.
• Excellent customer service skills.
• Advanced investigative and problem-solving abilities.
• Travel required (20%); a valid driver’s license with an acceptable motor vehicle report per company standards required if driving.

Benefits

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers .