Complex Claims Specialist

Athens Administrators; Orlando (FL); Hybrid; USD 96,000 - 123,000; Full time

Job summary

Athens Administrators is seeking a Complex Claims Specialist to join their Property & Casualty department. This full-time role involves reviewing and processing high-exposure claims while providing exceptional customer service. The position allows remote work on certain days, and candidates should have significant claims experience and relevant licenses.

Benefits

401k plan

Medical, Vision, Dental benefits

Continued education support

Qualifications

• 8-10 years complex/major claims experience.
• License in states such as NY, TX, or FL preferred.
• Maintain licenses and continuing education.

Responsibilities

• Review and analyze complex claims.
• Prepare comprehensive reports on claims trends.
• Manage litigation processes effectively.

Skills

Leadership

Analytical Skills

Negotiation Skills

Verbal Communication Skills

Written Communication Skills

Education

High School Diploma or equivalent (GED)

AA/AS or BA/BS preferred

Tools

Microsoft Office Suite

Job description

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Athens Administrators provided pay range

This range is provided by Athens Administrators. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$96,571.00/yr - $122,351.00/yr

ATHENS POSITION DETAILS

Position Title

Complex Claims Specialist – Property & Casualty

Department

Property and Casualty Claims

Reports To

Claims Supervisor

FLSA Status

Exempt

Job Grade

14

Career Ladder

Next step in progression could include Claims Supervisor

ATHENS ADMINISTRATORS

Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits—every single day! With offices throughout the United States, Athens Administrators offers Workers’ Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work!

Position Summary

Athens Administrators has an immediate need for a full-time Complex Claims Specialist to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, and WV). This position does allow for work from home if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week.

The Complex Claim Specialist is responsible for the review, investigation, analysis, and processing of complex claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure and often entail litigation and complex coverage. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines.

Primary Responsibilities

Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:

Advanced knowledge in the following areas: 1) Complex Auto or General Liability claims handling concepts, practices and techniques, to include but not limited to complex coverage issues, and product line knowledge, 2) advanced, functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills.

• Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability
• Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level
• Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management
• Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment
• Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure
• Ensure appropriateness of all coverage memorandums and payments
• Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications
• Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims
• Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities
• Provide superior customer service to all layers of authorities within the county
• Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account.
• May assist management in hiring other account dedicated examiners
• Provide guidance and serve as a technical expert to less experienced examiners
• May conduct meetings or training sessions to help develop less experienced examiners
• Attend all required meetings and educational seminars for professional development
• Conduct on-sight or frequent claim reviews in Ventura County with the client representatives, as required.
• Maintain required licenses
  
  

Essential Position Requirements

The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred
• Additional State Adjuster License(s), may be required within 180 days
• Maintain licenses and continuing education requirements in all states

• Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 8-10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims
• Experience with relevant insurance laws, codes, and procedures
• Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures
• Understanding Auto and General Liability exposure and unique coverage endorsements
• Understanding of medical, legal terminology and liability concepts
• Proficiency in investigation and resolution of severe to major level casualty claims
• Time Management and project management skills
• Strong negotiation and litigation management skills
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly, accurately and for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
• Must be able to reliably commute to meetings and events as required by this position
  

APPLY WITH US

We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.

This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.

Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

THANK YOU!

We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!

Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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