Senior Complex Claims Specialist managing high - severity Professional Lines claims from inception to resolution. Collaborating with legal and underwriting teams while providing mentorship to the claims team.
About the role
- To analyze mid- and higher-level general liability claims to determine benefits due;
- To ensure ongoing adjudication of claims within company standards and industry best practices;
- To identify subrogation of claims and negotiate settlements.
- Manages mid-level general liability claims by gathering information to determine liability exposure;
- Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
- Assesses liability and resolves claims within evaluation.
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- Manages subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Requirements
- Bachelor's degree from an accredited college or university preferred.
- Four (4) years of claims management experience or equivalent combination of education and experience required.
Benefits
- Flexible Work Schedule
- Referral Incentive Program
- Opportunity to work from home
- Career development and promotional growth opportunities
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
HS
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