Senior Complex Claims Specialist

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

📋 Description

• Manage the company’s most intricate casualty and litigated claims on a national scale.

• Actively oversee assigned claims until resolution while managing expenses and aiming for early resolution.

• Serve as a subject matter expert on complicated coverage matters and assist in reserve setting and claim resolution.

• Establish timely, precise, and well-documented reserves.

• Conduct investigations into coverage, liability, and damages while coordinating with appropriate vendors.

• Prepare evaluations of claims and conduct file reviews.

• Develop, document, and implement negotiation strategies.

• Maintain organized claim diaries and clear notes for case management and exposure assessment.

• Collaborate with defense counsel on strategic defense and resolution plans, including budgets and invoice assessments.

• Present claims during Claim Committee meetings and Complex Roundtables, facilitating discussions.

• Attend mediations and trials as required.

• Offer expert guidance and technical assistance to General Casualty, Complex, Specialty, and regional claims teams.

• Review and communicate evaluations of serious injury, intellectual property, and high-exposure claims.

• Assist claims adjusters, managers, directors, and leadership with issues needing special attention.

• Encourage enhanced technical claims handling in line with Best Practices.

• Identify, create, and provide training programs in collaboration with Learning and Development and claims leadership.

• Engage in special projects aimed at enhancing claims expertise and outcomes.

• Deliver exemplary customer service, updating insureds and agents on claim status and coverage details.

• Act as a technical subject matter consultant, recommending opportunities for development in technical claims handling.

⛳️ Requirements

• Bachelor’s degree, ideally in business, economics, or a related discipline, or equivalent relevant experience.

• A minimum of ten years in complex claims handling or claims litigation, including at least three years specifically in claims litigation.

• Preferred insurance designations such as AIC, CPCU, or other relevant insurance education.

• Extensive knowledge of litigation management, coverage, and technical file management.

• Strong understanding of claims-function theory and practice.

• Capability to assess legal liability, damages, coverages, and exposure.

• Excellent comprehension of insurance contracts, medical terminology, and legal aspects of court procedures impacting commercial-lines liability.

• Strong leadership, collaboration, and negotiation capabilities.

• Proficiency in computer systems and claims management software.

• Exceptional organizational, written, and verbal communication skills.

• Strong customer service abilities.

• Advanced investigative and problem-solving skills.

• Willingness to travel (20%).

• A valid driver’s license with a satisfactory motor vehicle report as per company standards is required for driving.

🏝️ Benefits

• Comprehensive benefits package including life, medical, dental, vision, and prescription drug coverage.

• Competitive paid time off plan.

• One full day of volunteer time off each year.

• 401(k) plan with company match.

• Pension plan.

• OneEMC bonus program.

• Recognition awards for service anniversaries.

• Opportunities for professional development and career growth.

• Tuition reimbursement programs.

• Wellness initiatives aimed at enhancing team member well-being and lowering health insurance costs.

• Flexibility to dress according to your daily schedule.

• Opportunities for alternative work arrangements.