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
- Handles complex claims with a focus on providing exceptional service and driving equitable resolutions within company standards
- Manages all aspects of a California complex claims inventory
- Communicates with policyholders, agents, attorneys, and witnesses to gather information and provide customer service
- Promptly investigates claims to determine exposure and works with appropriate experts
- Utilizes resolution tactics (mediation, negotiation, denial, litigation or offer) to drive results
- Directs defense counsel throughout the litigation process and monitors legal fees and costs
- Operates within state rules, regulations and internal claims handling policies and procedures
- Acts as a Subject Matter Expert and provides knowledge transfer across the organization
- Collaborates with team members from various departments for project and process discussions
- Makes recommendations for streamlining processes and adopting industry best practices
- Ensures accuracy of data in claims system for compliance with regulatory reporting
- Prepares and presents claims status reports for internal and external stakeholders
- Administers timely and appropriate benefits to injured workers and manages/approves payment of benefits within designated authority
- Creates and adjusts reserves in a timely manner to ensure consistency with company policies
- Resolves claims fairly and equitably, acting in the best interest of the insured
Requirements
- Bachelor's degree from an accredited institution (or equivalent education and experience)
- 8-10 years of related claims experience
- Workers’ Compensation: 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
- 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
- Adept at learning new technology and embrace change
- Facilitates and leads meetings across a team of claims professionals for assigned projects
- We are currently not offering employment sponsorship for this opportunity
Benefits
- Challenging work and the ability to make a difference
- You will have a voice and feel a sense of belonging
- We offer a 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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HS
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