Insurance

• The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team.
• Adjusts and resolves complex to severe claims that includes all phases of litigation
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and analyses claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors Claim Examiners
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
• Identifies emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Develops content and conducts training for claims team and underwriters as requested

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