Claims Specialist

• Investigating, evaluating, and negotiating general and auto liability claims.
• Conducting thorough investigations of coverage, liability, and damages.
• Communicating effectively with internal and external customers on claims issues.
• Maintaining and managing a diary system to manage claims inventory.
• Preparing Large Loss reports and maintaining ongoing claim updates.

Claims Analyst IV – Auto and GL

• To analyze Lost-Time Workers Compensation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Workers Compensation Claims Adjuster – DE & CT Jurisdiction Knowledge Required – PA NJ MA Preferred

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Workers Compensation Claims Examiner – CT, MA, NH, RI, VT Jurisdictional Knowledge

• Analyzing liability claim submissions for potential coverage
• Setting adequate case reserves
• Promptly and professionally responding to inquiries from customers and their brokers
• Proactively driving early resolution of claims arising from the Cyber, Tech PL, Media and/or Crime professional liability lines of business
• Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses for tech E&O, first and third party cyber claims
• Strategizing and maximizing early resolution opportunities
• Monitoring litigation and managing local defense and breach counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves

Complex Claims Specialist – Cyber Tech E&O, Media & Crime

• To analyze complex errors and omissions, directors and officers claims.
• To provide resolution of highly complex nature and/or severe injury claims.
• To coordinate case management within Company standards, industry best practices and specific client service requirements.
• To manage total claim costs while providing high levels of customer service.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim costs for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Delegates work and mentors assigned staff.
• Performs other duties as assigned.

Senior Claims Specialist – Professional Liability

• Handle and analyze general liability claims under general supervision
• Ensure ongoing adjudication of claims within company standards and best practices
• Analyze and process property damage claims with proactive handling
• Identify coverage issues and prepare comprehensive coverage letters
• Maintain claim files timely and properly documented

Claims Specialist III, Auto & General Liability

• Manages an active desk of general liability property damage claims under business owner policies
• Analyzes coverage issues under the Business owners coverage form, Excess and Umbrella coverage form, Garagekeepers, Hired/Non-owned Auto, Auto Services and other standard industry forms
• Analyzes, investigates, and evaluates new loss notices and claim tenders
• Handles litigated claims and actively coordinates and strategizes with defense counsel
• Expeditiously analyzes and positions claim under applicable coverage
• Collaborates on setting reserves at appropriate level for claims
• Uses good judgment in managing ALAE in claims investigation
• Appropriately documents claim files in accordance with established guidelines
• Obtains and maintains adjuster licenses, as required

Senior General Liability Claims Representative – Property Damage

• Analyze Lost-Time Workers Compensation claims on behalf of clients to determine benefits due.
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Workers Compensation Claims Adjuster – CT, MA Jurisdictions, CT License

• Be a decision maker. Focus on solving complex problems, while making timely, but thoughtful decisions to resolve client issues.
• Analyze medical, financial, and other claim documents.
• Have opportunities to meet with our customers in person.
• Provide accurate claims decisions in a time sensitive and fast- paced environment, while adhering to all state and department of insurance regulations.
• Be a leader Work across business divisions including both internal and external partners.
• Be a resource for colleagues with less experience.
• Work on department innovations.

Senior Individual Disability Claims Specialist

• Adjusts and resolves low to moderate professional liability claims that include litigated matters
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Heavy customer facing role. Must have confident communication skills. Communicates effectively to resolve matters directly with claimants, and or claimant attorneys
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Reviews and analyzes claims in order to determine appropriate and timely reserving per Hiscox Claims Best Practices
• Identifies emerging exposures and claims trends
• Manages defense counsel as necessary in defending litigated matters
• Identifies suspected fraudulent claims and tracks with Special Investigations Unit
• Participates in Claims Projects, as needed

Senior Claims Examiner – MPL

• Responsible for the handling of high-severity primary Professional Lines claims from inception to resolution
• Adjusts to resolution the highest severity claims and drafts the most complex technical coverage analysis and letters required
• Acts as subject matter expert within the team
• Models gold standard for litigation best practices and file integrity
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and alternative dispute resolutions
• Identifies and provides potential solutions for emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant correspondence and notes
• Mentors other team members, including providing formalized training, as needed

Senior Complex Claims Specialist, PL & Specialty Severity

• Adjusts and resolves complex mid to severity claims that include all phases of litigation
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and provides analysis of claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors team members
• 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

Complex Claims Specialist – MPL

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property losses and damages.
• Effectively communicate and negotiate with policyholders, agents, public adjusters, attorneys, and service providers via phone, email, and internal systems to accurately document claim details.
• Successfully manage a pending claim load at varying stages of the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Interpret and apply computer generated loss estimates, engineer’s reports, and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.
• Mentor our mid and associate level claims representatives.

Complex Claims Representative

• Handles healthcare malpractice/negligence claims including analyzing coverage and communicating coverage positions
• Conducts, coordinates, and directs investigation into loss facts and extent of damages
• Confirms coverage of claims by reviewing policies and documents submitted in support of claims
• Drafts coverage position letters
• Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
• Handles claims in all jurisdictions
• Handles litigated and non-litigated bodily injury claims with values up to $450,000 in all jurisdictions
• Represents Markel in mediations
• Monitors trial, as required
• Sets reserves within authority or makes recommendations concerning reserve changes to manager

Senior Claims Examiner, Medical and Healthcare Claims

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

Claims Specialist – Large Loss

Workers Compensation Claims Examiner, CT, MA, NH, RI, VT Jurisdictions

• The Senior Claims Examiner adjudicates assigned claims within given authority and provides operational support to the claims team.
• Adjusts and resolves moderate to complex claims that includes all phases of litigation
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Reviews and analyses claim documentation and legal filings to set timely and accurate reserves and notify the manager if upward segmentation is needed
• Identifies emerging exposures and claims trends
• Drives litigation best practices to manage deployment and utilization of defense counsel
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Participates in Claims Projects as needed

Senior Claims Examiner

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Claims Specialist II

• Investigate and determine compensability on workers' compensation claims
• Develop and implement effective claim resolution strategies
• Support return-to-work efforts through medical and disability management
• Evaluate and negotiate claim settlements and work with defense to handle litigation matters
• Ensure compliance with RI statutes, regulations, and Beacon’s internal guidelines
• Reserve, process, and manage claims payments accurately and efficiently

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