Claims Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• In-depth interpretation of policy documents and legal contracts.

• Proven ability to analyze and pinpoint coverage and related issues.

• Utilize a solid understanding of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, and best practices in claims handling and management during claims adjudication.

• Oversee, investigate, and resolve claims within established authority levels.

• Propose final resolutions on cases exceeding authority to claims management.

• Depend on extensive litigation experience in both General Liability and Casualty files to effectively resolve claims.

• Actively pursue litigation, participate in mediations, trials, and other alternative dispute resolution methods.

• Engage with policyholders, witnesses, and claimants to collect information related to claims, delegate tasks to additional resources as needed, and advise on the appropriate course of action.

• Proactively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status updates.

• Present file materials for authority and roundtable discussions.

• Collaborate with nurses, doctors, and attorneys for file assessments.

• Adhere to all statutory and regulatory requirements applicable to all jurisdictions.

• Meet stringent quality assurance standards and achieve established performance goals.

• Set and adjust case reserves according to the reserving policy.

• Identify potentially suspicious claims and refer them to SIU; recognize opportunities for third-party subrogation.

• Ensure the security of financial processes related to claims, as well as the protection of information in claims files.

• Work with independent field adjusters and provide claim-specific guidance.

• Collaborate closely with internal teams and inform leadership of significant claim activities and risks.

⛳️ Requirements

• A BS/BA Degree is required.

• Preferred advanced studies or insurance designation.

• A minimum of 15+ years of relevant experience in Commercial General Liability and Litigation.

• Required strong written and oral communication skills, along with strong interpersonal, analytical, investigative, and negotiation abilities.

• Comprehensive knowledge of multi-jurisdictional claims handling issues.

• Willingness to embrace and adapt to changing technologies within Claims operations.

• Must be a self-motivated individual capable of working independently.

• Candidates must possess, or be able to quickly obtain, a Texas Independent Adjuster License.

• Effective skills in communication, presentation, negotiation, and persuasion.

• Ability to work collaboratively with cross-functional teams to achieve business objectives.

• Demonstrated success in delivering excellent results in a dynamic claims environment.

• A commitment to achieving excellence in work processes and outcomes while adhering to company policies and regulatory compliance.

• A team-oriented mindset that focuses on fostering strong working relationships and contributing to a positive workplace culture.

• High comfort level with navigating occasionally ambiguous situations, along with a willingness to assist coworkers with workloads or contribute to organizational projects as needed.

• Openness to feedback and a desire to learn, embracing continuous improvement and adapting to new proprietary and off-the-shelf software systems.

• Some travel availability, likely up to 10% of the time.

🏝️ Benefits

• Partially subsidized medical plan.

• Fully subsidized vision and dental options.

• Life insurance coverage.

• Disability insurance.

• 401(k) plan.

• Flexible paid time off.

• Parental leave.