Claim Specialist

• Review assigned claims
• Contact insureds and other affected parties
• Set expectations for the remainder of the claim process
• Thoroughly document activities in claim files
• Complete complex coverage analyses and identify all possible policyholder benefits
• Investigate claim facts
• Determine whether claims should be paid and confirm recovery potential
• Review damages and determine applicability of state law and other claim-related factors
• Refer claims to Underwriting, Subrogation, or the Special Investigation Unit when appropriate
• Handle attorney-represented and unrepresented injury claimants involving coverage investigations, liability disputes, bodily injuries, and litigation
• Assist the Claim Manager with file reviews and training
• Work within assigned claim systems and process time-sensitive information from multiple sources
• Travel outside the assigned territory when needed

Senior casualty claims specialist resolving complex Florida injury claims for AAA insurance services

Senior Casualty Claim Specialist

Senior casualty claims specialist handling complex Florida bodily injury and litigation claims. Supporting AAA’s insurance, travel, membership, and financial services operations.

• Investigate, evaluate, reserve, negotiate, and resolve assigned Specialty Liability bodily injury and property damage claims
• Handle claims throughout the full claim life cycle, including customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation, and resolution
• Provide quality customer service and ensure timely coverage analysis and communication with insureds
• Investigate claims through contact with policyholders, claimants, witnesses, agents, medical providers, law enforcement, and technical experts
• Interview witnesses and stakeholders and obtain statements
• Select and direct internal and external resources, including subrogation, risk control, nurse consultants, fire or fraud investigators, and other experts
• Verify injuries and property damage through records and documentation
• Maintain claim files and document activities according to procedures
• Create Claim File Analysis and use evaluation documentation and diary management systems
• Evaluate liability and damages exposure and establish indemnity and expense reserves
• Participate in roundtables and authority discussions
• Develop and employ creative claim resolution strategies
• Negotiate claim dispositions with insureds, claimants, and legal representatives
• Manage litigated claims, litigation plans, counsel, claim strategy, discovery, and legal expenses
• Attend depositions, mediations, arbitrations, pre-trials, trials, and other legal proceedings as needed
• Update relevant parties on new facts, liability analysis, and settlement options
• Refer severe or complex cases to another level of claim professional when appropriate
• Fulfill service commitments for specified accounts and respond to agent and broker inquiries
• Represent Travelers as a technical resource within professional guidelines and applicable state laws
• Mentor and coach less experienced claim professionals
• Collaborate with business partners to achieve and sustain quality results
• Evaluate claims for recovery potential and handle or direct recovery efforts
• Perform other duties as assigned
• Potential for 30% travel

Construction claims specialist investigating and resolving complex liability claims for Travelers property-casualty insurance

Construction Claim Technical Specialist

Construction claims specialist investigating and resolving complex liability claims for Travelers property-casualty insurance. Managing coverage, litigation, negotiation, reserves, and recovery efforts across assigned claims.

• Analyze coverage and communicate coverage positions
• Conduct, coordinate, and direct investigations into loss facts and extent of damages
• Confirm claim coverage by reviewing policies and supporting documents
• Draft coverage position letters
• Evaluate coverage, liability, and damages to determine insured exposure
• Handle claims in all jurisdictions
• Handle litigated and non-litigated property damage claims valued up to $250,000
• Handle non-litigated bodily injury claims valued up to $250,000
• Handle smaller product liability and construction defect claims
• Identify losses that should be reported to SIU
• Participate in special projects and assist team members
• Provide professional customer service while maintaining production
• Represent Markel in mediations as required
• Set reserves within authority or recommend reserve changes to the manager

Construction claims specialist resolving commercial insurance claims for Markel

Claim Specialist II, Construction Defect

Construction claims specialist resolving moderate-complexity commercial insurance claims for Markel. Investigating coverage, liability, damages, reserves, and litigation across multiple jurisdictions.

• Provides production support to multiple groups within Operations Services or enterprise wide
• Executes a variety of routine tasks within multiple operational systems
• Interacts with multiple internal partners
• Duties may include functions related to payment transactions or claim processing, data entry, archiving, researching, troubleshooting and vendor/client interaction
• May have direct contact with 3rd party vendors and / or external customers
• Researches exceptions and escalates issues to management as appropriate
• May have the opportunity to recommend and implement developed processing improvements within production

Production support role in Operations Services at U.S. Bank

Production support role in Operations Services at U.S. Bank providing support to multiple groups and responsibilities across operational systems. Involves payment transactions, data entry, and vendor interactions.

• Investigate, evaluate, and negotiate settlements while applying technical knowledge and skills to effect fair and prompt resolution of cases.
• Adjust reserves and provide recommendations to ensure reserving activities are consistent with corporate policies.
• Effective communication of reserve and reinsurance notices and reports.
• Communicate promptly and professionally with all parties when answering questions and gathering claim information.
• Adhere to company service standards and claims handling guidelines.
• Effectively manage and control litigation and claim expenses (budgets, experts, and claim strategies).
• Confer and direct legal counsel on claims requiring litigation, attend mediations, arbitrations and/or trials when necessary.
• ISO claim input and reporting.
• Resolve claims within designated authority level.
• Maintain claim files with professional notes, claim summary, detailed analysis, and specific action plan with target dates.
• Perform other duties as assigned by management and mentor less experienced staff.

Complex Casualty Claim Specialist managing complex casualty/bodily injury claims

Complex Casualty Claim Specialist

Complex Casualty Claim Specialist managing complex casualty/bodily injury claims for Northeast customers. Investigating and negotiating settlements while operating remotely during EST business hours.

• Handle a caseload of bodily injury and non-bodily injury claims that involve complex coverage and liability issues
• Provide oversight and direction to third-party administrators
• Support CLS underwriters and account managers in sales activities on new and renewal business
• Communicate written position(s) to insureds and other required parties
• Set appropriate expense and indemnity reserves
• Present cases to management for authority above established levels
• Manage litigation and counsel
• Provide periodic claims reviews for individual insureds
• Attend trials and mediations as necessary
• Prepare reports and deliver presentations to senior claim leadership
• Address time limit demands and evaluate complexity issues
• Liaise between CLS and various third-party administrators, internal departments like billing and reinsurance accounting.

Claim Specialist managing complex liability claims for an insurance company

Claim Specialist – Complex Liability Solutions

Claim Specialist handling complex liability claims for The Hartford's Global Specialty Liability unit. Collaborating with underwriters, managing litigation, and providing oversight to third-party administrators.

• Inspect property damage, investigate claims, and provide exceptional service.
• Review assigned claims and contact the insured and other affected parties.
• Conduct thorough reviews of damages and determine applicability of state law.
• Approve payments for the appropriate parties and document claim activities.
• Utilize strong negotiating skills to reach fair claim resolutions.

Field Property Claim Specialist inspecting and resolving claims in Metro Detroit area

Field Property Claim Specialist

Field Property Claim Specialist for The Auto Club Group inspecting property damage and managing claims in Metro Detroit area. Engage with homeowners to provide exceptional service and resolutions.

• Evaluate coverage for assigned claims.
• Assess claim exposures and make informed decisions for resolution.
• Manage challenging and complex claim scenarios while ensuring compliance with regulations.
• Review assigned claims and initiate claim handling activities.
• Contact insureds and other affected parties to gather information.
• Document claim activity and maintain accurate records.
• Perform complex coverage analysis and identify applicable policyholder benefits.
• Establish and manage sub-claims as needed.
• Conduct thorough investigations to determine coverage applicability, claim validity, and other relevant factors.
• Negotiate settlements and claim resolutions.
• Refer claims to specialized departments when necessary.
• Ensure complete and accurate claim documentation and compliance with procedures.

Claim Specialist managing Michigan PIP claims for The Auto Club Group

Claim Specialist – PIP

Claim Specialist evaluating coverage and managing Michigan PIP claims for The Auto Club Group. Collaborating with members and legal partners for accurate claim handling and resolutions.

• Manage complex Michigan Personal Injury Protection (PIP) claims from inception through resolution.
• Review assigned claims and contact the insured and other affected parties.
• Complete complex coverage analysis.
• Ensure all possible policyholder benefits are identified.
• Document and/or code the claim file and complete all claim closure activities in the claims management system.
• Utilize strong negotiating skills and approve payments to appropriate parties.
• Work with insureds, guardians, conservators, and attorneys to complete claims review process.

Senior PIP Claim Specialist managing complex Michigan PIP claims for AAA

Senior PIP Litigation Claim Specialist

Senior PIP Claim Specialist managing complex Michigan PIP claims at AAA. Responsible for claims handling, negotiation and ensuring policyholder benefits are maximized.

• Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure.
• Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
• Evaluates claim exposure, negotiate and resolve claims.
• Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary.
• Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
• Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
• Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
• Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
• Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
• Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
• Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
• Prepares and presents files for Agent/Broker Reviews and Insured File Review.
• Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
• Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
• Maintains a working knowledge of all computer systems currently in use.
• Travels throughout States as required to handle claims inventory assigned.
• Continues education in claims through Associate in Claims or Claims Law (AEI) courses.

Claim Specialist handling workers' compensation claims at MEMIC

Claim Specialist III

Claim Specialist handling workers' compensation claims at MEMIC. Investigating, evaluating, negotiating, and resolving lost time claims efficiently and effectively.

• Initial and ongoing investigation of D&O and general management liability claims.
• Assertive daily handling of complex claims, litigation, high exposure cases and coverage issues.
• Providing prompt and accurate coverage positions and liaising with counsel appointed or chosen by insureds to assess liability and exposure and determine litigation defense strategy.
• Review, analysis and reporting on legal documents and motion practice associated with claims.
• Appointing and liaising with coverage counsel to the insurer.
• Ongoing communication and reporting to Unit and Team claims leaders.
• Attendance at or assistance with underlying litigation and coverage mediations.
• Providing appropriate reporting on files to the unit leader and or sr. management with recommendations on reserving, plan of action, and current evaluation as required.
• Acting independently in evaluating claim exposures with assigned dollar authority.
• Attend business related functions, such as team meetings, mediations, trials, company events, etc.
• May perform other related tasks as assigned, depending on business need.

Chief Claim Specialist at RSUI handling complex D&O claims in Atlanta

Chief Claim Specialist – ML, D&O

Chief Claim Specialist at RSUI providing specialized claim handling expertise for D&O claims. Managing complex claims with a focus on collaboration and high-performance culture.

Claim Specialist jobs in United States

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