Claims Specialist

A Claim Specialist works independently or with minimal direction, managing claims that present high exposure and/or complex coverage or liability issues for all lines of business:
Homeowners, Personal Auto, Commercial Auto, Garage Keeper, Commercial Liability and Farm Liability.

Salary Grade (13) 76,101 - 97,

Determines coverage, liability, sets and adjusts reserves, evaluates the claim, manages the litigation and negotiates settlements. Works within prescribed authority limits handling claims. Investigate and determine liability of all parties involved. Ensures delivery of high-quality customer service to protect our insured, and assets of the company. Demonstrates a high level of expertise and sound judgment in complex matters; may serve as a subject matter expert.

Required to manage assigned caseload of casualty losses in accordance with Company standards and IC 27-4-1/ORC 3901-1-54.

The following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Coverage/Investigation/Liability - Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness.
• Damages - Determines the value of the physical damage of property, automobiles, or injuries through physical inspections and use of appropriate tools. Obtains all necessary documentation to support claim evaluation. Recognizes claim file exposures and escalates appropriately.
• Reserving/Reporting - Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. Completes appropriate reports so that the status of the claim is clearly documented at all times.
• Determines need for, and engages independent adjusters, cause and origin experts, independent medical examiners or other experts (e.g. reconstructionist, engineer).
• Proficiently and proactively handle the claim file through various phases of litigation. Independently review the applicability of coverage and civil law as well as local statutes. Attend mandatory and court ordered litigation events: mediation, pre‑trial, trial.
• Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to coverage, liability and damages. May analyze the impact upon claims policies and procedures and advises Claims Management. Participates in or leads special projects and mentors others, as needed.
• Initiate prompt and effective communication with all parties having legal or contractual interest in claim presented.
• Capable of drafting clear and concise letters and other correspondence.
• Accountable for security of financial processing of claims, as well as security information contained in claims files.
• Confers directly with policyholders on coverage and resolution issues pursuant to Home Office instructions.
• Prepare claims for trial, comply with trial alert procedures and notify/update reinsurance when appropriate.
• Participate in training programs, conferences and departmental and intra‑departmental meetings.
• May be required to be on‑call, on a limited basis, for after‑hour emergencies.
• Any other duties deemed necessary by supervisor or management.

None

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

College Degree or Equivalent Experience

At Least 3 years as a Sr. Claim Representative or equivalent preferred

Excellent Interpersonal Skills

Superior Organizational Skills

Ability to Demonstrate effective negotiation skills

Excellent…