Senior Complex Claims Specialist, Major Case Unit

Senior Complex Claims Specialist

 

Job Summary
Seeking an experienced Senior Complex Claims Specialist to oversee large exposure and complex general liability, auto liability, and trucking claims. This role focuses on managing claims handled by third-party administrators (TPAs) while supporting internal stakeholders and ensuring effective resolution strategies. The position does not include direct staff management but requires oversight of the claims process and TPA performance.

 

Responsibilities

• Provide technical oversight on high-exposure and complex claims, ensuring timely resolution and superior outcomes.
• Collaborate with TPA staff, Claim Account Managers, underwriters, legal teams, and internal stakeholders to execute claim strategies.
• Communicate effectively with insureds and brokers, delivering exceptional customer service.
• Conduct coverage analysis, investigations, liability and damage evaluations, and reserve setting within granted authority.
• Manage litigation, vendors, settlement negotiations (including structured settlements), and overall claim resolution.
• Maintain accurate claim file documentation, coding, and diary management.
• Partner with defense and coverage counsel to develop litigation strategies, manage budgets, and review legal invoices.
• Prepare timely claim reporting and updates for management and business stakeholders.
• Participate in mediations, trials, and related proceedings.
• Ensure compliance with state adjuster licensing requirements.
• Support TPA oversight, including staff training, best practice sharing, claim audits, file reviews, and regular meetings.

 

Qualifications/Requirements

• Juris Doctorate degree preferred.
• Minimum of 10 years of commercial general/auto liability claims experience, including complex and large-exposure files, or equivalent law firm insurance defense/coverage experience.
• Experience with trucking, construction, or emergency services/medical professional liability claims preferred.
• Prior TPA management or oversight experience preferred.
• Strong negotiation, analytical, and problem-solving skills.
• Excellent written and verbal communication, collaboration, and interpersonal abilities.
• Proven ability to manage complex information, distill key issues, and present concise recommendations.
• Skilled in leading strategic discussions and making cost-effective decisions.
• Highly adaptable, independent, and team-oriented.
• Proficiency with Microsoft Excel, PowerPoint, and Word.
• Willingness & ability to travel up to 10% of the time.

 

Compensation Package

• Compensation: Between $160K–$180K (based on experience).
• Competitive benefits package, paid time off, professional development opportunities, etc.

 

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

 

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