Senior Claims Specialist, Workers Compensation - Small Commercial

Description

*** CA, OR, NV and/or NY workers' compensation claims experience are preferred but not required. ****

 

Candidates residing within 50 miles of a hub location will be subject to in-office requirements.

 

This is a grade 13-14 range posting depending on experience and qualifications.

 

The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. The Senior Claims Specialist may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.

 

Responsibilities:

• Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company.
• Acts as senior technical professional on team, assisting team members with escalated issues.  Mentors and trains new team members.  Participates in Quality Review process. 
• Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews.
• Performs other duties as assigned.

Qualifications

• Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required.
• Demonstrated leadership ability and time management skills to delegate work appropriately and organize resources effectively.
• Demonstrates an expert level knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state`s tort laws as normally acquired through a bachelor`s degree or equivalent training plus 4 to 6 years directly related work experience (at least two of which should ordinarily be in a team leader capacity).
• Licensing required in some states.

 

Employees may apply for a new role after completing 12 months of employment in their current position.

 

Employees should review all role requirements and apply only for positions for which they are eligible. Hiring processes may vary by country, including differences in procedures, requirements, and timelines.  For country-specific details, please consult your local recruiting / HR team.