Complex Claims Specialist

Argo Group and Farm Family are specialty property and casualty insurance brands whose underwriting companies are wholly owned subsidiaries of Brookfield Wealth Solutions, a leading provider of wealth and insurance solutions. Argo and Farm Family partner with agents and brokers to help businesses stay in business, delivering collaborative insurance solutions for niche markets.
** Job Description
** PURPOSE OF THE JOB:

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.

ESSENTIAL FUNCTIONS:

* 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.

ADDITIONAL RESPONSIBILITIES:
* 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.

REQUIRED QUALIFICATIONS:

* Bachelor's degree.
* Six to eight years of experience.
* Supervisory/management experience not applicable.

ADDITIONAL QUALIFICATIONS:

* Completion of the appropriate insurance designation.
* Training on Medical Terminology.
* Maintain continuing education (CE) requirements for state licensing.
* Documented history of successfully handling complex, high exposure claims.
* Documented proficiency in written and verbal communication.

PREFERRED QUALIFICATIONS:

* Insurance designations, AIC, SCLA, CLMP, CPCU.JOB FAMILY:
** Level I:
Complex Claims Specialist
**…