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
- This Claims Specialist is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards.
- Manages all aspects of a complex claims inventory.
- Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service.
- Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations.
- Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results.
- Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures.
- Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.
- Consistently provides exceptional customer service.
- Effectively collaborates with team members from various departments for project and process discussions.
- Acts as a Subject Matter Expert for the department.
- Makes recommendations for streamlining processes and adopting the industry’s best practices.
- Ensures accuracy of data in claims system for compliance with applicable regulatory reporting.
- Provides knowledge transfer across the organization.
- Continuously seeks to improve technical skills by attending job-related training and tracking current case law.
- Acts as a mentor and provides training for less experienced team members.
- Prepares and presents claims status reports for internal and external stakeholders.
- Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level.
- Works within applicable state rules, regulations as well as ICW Group’s internal claims handling policies and procedures.
- Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies.
- Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law.
Requirements
- Bachelor's degree from an accredited institution (or equivalent education and experience) along with 8-10 years of related claims experience.
- Certification that meets the minimum standards of training, experience, and skill required.
- WCCA and WCCP preferred.
- State Workers Compensation License is required in some branches.
- Thorough understanding of laws and jurisdictional restraints to manage injuries.
- Excellent verbal and written communication skills, time management, attention to detail and organizational skills required.
- Ability to read, analyze, and interpret technical journals, financial reports, and legal documents.
- Ability to write reports, business correspondence, and procedure manuals.
- Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
- Ability to effectively present information to management, public groups, and/or boards of directors.
- Must be adept at learning new technology and embrace change.
Benefits
- Competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
- Bonus potential for all positions
- Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
- 11 paid holidays throughout the calendar year
- Want to continue learning? We’ll support you 100%
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