Complex Claims Specialist

BP&C • Springfield, MO

14h • $69,000 - $105,000

About The Position

The Complex Claim Specialist is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure claims. This includes assessing coverage; contacting the insureds, claimants, and witnesses; engaging experts when needed to fully investigate the facts of the loss and to arrive at a proper conclusion in assessing liability and damages. The Complex Claim Specialist is ultimately responsible for liability and coverage decisions, damage assessments and the negotiation of a claim to conclusion. Handling UM/UIM exposures and reviewing litigation strategy and actions of defense counsel for claims involving Arbitration. Provide the insured with the promise of the policy and excellent customer service.

Requirements

• Bachelor's degree.
• Six to eight years of experience.
• Documented history of successfully handling complex, high exposure claims.
• Documented proficiency in written and verbal communication.

Nice To Haves

• Insurance designations, AIC, SCLA, CLMP, CPCU.
• Completion of the appropriate insurance designation.
• Training on Medical Terminology.
• Maintain continuing education (CE) requirements for state licensing.

Responsibilities

• Completion of an initial review and analysis of the policy coverage to determine if coverage is applicable.
• Address any excess policies that may be applicable to the loss.
• Completion of the claim investigation, and/or review of the initial investigation on reassigned files to property assess and evaluate the liability exposure and to ensure proper reserving for a given exposure in accordance with the company’s reserving philosophy.
• Secure recorded statements from all parties; document file activity in a concise and comprehensive manner.
• Handling claims that have the greatest complexity and severity, with the highest exposure to the company and to the insured, which may include excess umbrella policies.
• Completion of claim evaluations with settlement authority recommendations and present those recommendations to upper management.
• Negotiation of claims to a proper resolution within the authority extended.
• Attend mediations if as and when required.
• Handling all fatality and pedestrian losses.
• Proactively move files toward a proper resolution.
• Establish and maintain an appropriate diary on all files.
• Consult with defense counsel or medical experts if needed.
• Applies cost containment methodology, when appropriate, claim review for medical necessity and reasonable and customary charges.
• Utilizing third party bill reviews when applicable.
• Report to Underwriting when information is developed requiring a risk analysis of the policy.
• Communicate with agents, providing updates, inquiries and alerts.
• Process claims according to applicable state mandates/statutes; investigate, review and stay current on applicable case law.
• Demonstrates responsibility in making liability assessments for first- and third-party losses, send required forms and state compliance documents/letters.
• Obtain appropriate releases, court approved settlements for minors, or estate claims, structured settlements.
• Attend pre-suit mediations.
• Handle demands for Arbitrations and discovery associated with those claims.
• Ensure compliance with state regulations and requirements.
• Considers alternative dispute resolutions, utilizing creative resolutions when appropriate, to reach an effective resolution of a dispute.
• Makes daily decisions to determine the appropriate course of action for the file, considering the exposure of the insured, the company, cost, and risk factors.

Benefits

• We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program—including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level