Claims Specialist

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

📋 Description

• Act as a subject matter expert within the Claims department.

• Manage high-severity and high-complexity commercial claims.

• Interpret policy documents and legal agreements.

• Analyze and pinpoint coverage and related issues.

• Utilize knowledge of insurance contracts, claims practices, insurance codes, civil codes, vehicle codes, arbitration rules, regulations, and tort law.

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

• Suggest resolutions for cases that exceed authority to claims management.

• Handle litigation associated with General Liability and Casualty files.

• Drive litigation efforts and participate in mediations, trials, and alternative dispute resolution processes.

• Engage with policyholders, witnesses, and claimants to collect claim information and advise on suitable actions.

• Address written and phone inquiries, including status updates.

• Present file materials for authority reviews and discussions.

• Collaborate with nurses, doctors, attorneys, and independent field adjusters on file evaluations and claim-specific guidance.

• Adhere to statutory and regulatory requirements.

• Achieve quality assurance standards and performance targets.

• Set and adjust case reserves in accordance with the reserving policy.

• Identify suspicious claims and refer them to the Special Investigations Unit (SIU).

• Recognize third-party subrogation opportunities.

• Ensure the security of financial claim processing and information in claims files.

• Collaborate with internal teams and provide leadership with insights on claim activities and exposures.

⛳️ Requirements

• Bachelor's degree (BS/BA) is required.

• Advanced studies or an insurance designation is preferred.

• Minimum of 10+ years of relevant experience in Commercial General Liability and Litigation.

• Excellent written and verbal communication skills.

• Strong interpersonal, analytical, investigative, and negotiation skills.

• Comprehensive understanding of multi-jurisdictional claims handling issues.

• Willingness to adopt and adapt to evolving technologies within Claims operations.

• Ability to work autonomously and demonstrate self-motivation.

• Must possess or be able to quickly obtain a Texas Independent Adjuster License.

• Proficient communication, presentation, negotiation, and persuasion skills.

• Ability to work collaboratively with cross-functional teams.

• Proven track record of achieving strong results in a fast-paced claims environment.

• Commitment to excellence, adherence to company policies, and regulatory compliance.

• Team-oriented mindset with the ability to foster strong working relationships.

• Comfortable navigating ambiguous situations and assisting colleagues with workloads or organizational projects.

• Open to feedback and dedicated to continuous improvement, including learning proprietary and off-the-shelf software systems.

• Willingness to travel, likely up to 10%.

🏝️ Benefits

• Annual performance-based incentive program.

• Partially subsidized medical plan.

• Fully subsidized vision and dental options.

• Life insurance coverage.

• Disability insurance.

• 401(k) retirement plan.

• Flexible paid time off policy.

• Parental leave benefits.

• Commitment to equal employment opportunities and fostering a diverse, inclusive, and respectful workplace.