Claims Specialist - Executive Claims Specialist

Claims Specialist - Executive Claims Specialist

Alpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual Req #84

Wednesday, April 10, 2024

Job Summary

The Claims Specialist will manage a caseload of pending insurance claims with minimal supervision. Job functions include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of the insured's or insurer's liability; Reviewing and evaluating damages and determining strategies for resolution; settling claims in accordance with policy provisions and within authority level. The Claims Specialist will engage in verbal and written communication with brokers, claimants and policyholders. The Claims Specialist will ensure that state claims handling requirements are met, and internal guidelines are followed. The Claims Specialist will handle claims in accordance with James River Claims Best Practices. The Claims Specialist will function independently and will act as a resource person and consultant on issues within area of specialty.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Perform coverage, liability, and damage analysis on all claims assignments
• Investigate allegations, determine facts based on evidence and interviews
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to independent licensed professionals
• Negotiate settlements, mitigate losses, and control expenses
• Manage litigated files in accordance with Litigation Management Guidelines
• Provide technical guidance, assistance and training as needed for claims staff and other departments
• Maintain a high level of communication with leadership
• Work within authority limits on assignments that reflect a high degree of technical complexity and coordination
• Will be recognized as the company consultant within specialty area
• Handle special projects related to specialty area as needed

Knowledge, Skills and Abilities

• Excellent written and verbal communication skills
• Strong analytical skills
• Strong negotiation skills
• Ability to work independently
• Excellent organizational skills
• Proficient computer skills
• Ability to work in a team environment and take directions from a Claims Manager
• Ability to work on assignments that require a high technical level of expertise due to complexity and exposure, under minimal supervision
• Recognized as having a high level of expertise in claim handling and suit management
• Ability to provide technical guidance and assistance, and train less experienced Claims Examiners
• Possess demonstrated technical knowledge and skills, including product and industry, reflective of successful progress

Experience and Education

Claims Specialist

• High school diploma required
• College degree preferred
• Advanced degree or law degree preferred
• Minimum of seven years claims handling experience
• Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
• Experience working with complex coverage issues
• Multi-jurisdictional claims and litigation experience
• Adjuster license and/or certifications desired preferred

Executive Claims Specialist

• High school diploma required
• College degree preferred
• Minimum of fifteen years multi-line claims handling experience, with concentration in litigation
• Project management and process implementation experience preferred
• Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
• Experience working with complex coverage issues
• Adjuster license and/or certifications preferred

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