Complex Claims Specialist (Remote)

Selective Insurance; United States; On-site; USD 124,000 - 160,000; Full time

Benefits offered by this job

Total rewards package

Job summary

Selective Insurance is seeking a senior claims specialist to directly handle its most complex and challenging claims. You will conduct coverage analysis, investigations, evaluations, negotiations and dispositions, while managing litigation activities and budgets in line with policy guidelines.

The role requires strong communication, strategic negotiation, and risk management skills, with travel including mediations, arbitrations, trials, and conferences up to 20% of time.

Qualifications

• Experience with complex coverage analysis and large loss evaluations.
• Superior communication and strategic negotiation and claim disposition skills.
• Excellent presentation skills and proficiency with standard business software.

Responsibilities

• Evaluate and resolve coverage issues for all lines of business and liability claim types.
• Investigate claims via telephone, written correspondence, and in-person with claimants, attorneys, insureds, and witnesses.
• Manage vendors and expenses efficiently.
• Analyze information to assess extent of loss and arrange medical examinations when needed.
• Negotiate and resolve claims within delegated authority ($100,000–$400,000).
• Provide reports to claims, underwriting, reinsurance and actuarial on significant exposure cases.
• Report on trials and attend proceedings when warranted or requested.
• Coordinate referrals to reinsurers and oversee related items.
• Travel up to 20% and drive as needed.

Skills

Complex coverage analysis

Litigation management

Negotiation and disposition

Communication

Problem solving

Presentation skills

Education

Juris Doctor (JD)

Bachelor’s degree

Tools

Microsoft Outlook

Excel

PowerPoint

Job description

Overview

The purpose of this position is to provide direct handling of the company’s most complex and challenging claims. Responsibilities of this position include coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims. Candidate must possess strong litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The individual in this position will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority with exceptional standards of performance. This individual should possess strategic though process skills to effectively and efficiently manage loss exposures. Job duties will include communication and collaboration with key stakeholders, training, development and providing thought leadership where requested. In addition, position may require travel to mediations, arbitrations, settlement conferences, trials or other proceedings which may account for up to 20% of the specialist time. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

Responsibilities

• Effectively evaluate and resolve coverage issues for all lines of business and all liability claim types.
• Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information.
• Effectively and efficiently manage vendors and expenses.
• Timely analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary.
• Effectively evaluate, negotiate and resolve claims within delegated authority (ranging from $100,000 to $400,000) utilizing the appropriate denials or releases.
• Provide required reports to claims, underwriting, reinsurance and actuarial on significant exposure cases.
• Report on all cases going to trial on a timely basis and attend portions of trials when warranted or where requested by management.
• Ensure proper referrals and timely updates to appropriate Reinsurer(s).
• Ability to handle or oversee Extra-Contractual, EPLI, Social Services and E&O claims against the Company.
• Must be able to drive an automobile to travel within territory. Car travel represents approximately 10-25% of employee’s time and a valid driver’s license.
• Travel, including air travel with overnight stays, is about 10% of the job.

Knowledge and Requirements

• Experience in complex coverage analysis and significant large loss evaluations.
• Superior communication and strategic negotiation and claim disposition skills along with proven problem-solving skills.
• Excellent presentation skills and moderate proficiency with standard business-related software (including Microsoft Outlook, Excel, and PowerPoint).
• Sufficient keyboarding proficiency to enter data accurately and efficiently.
• Multi-State licensing with strong understanding of Medicare reporting & compliance preferred.
• Must have valid state-issued driver’s license in good standing and be able to drive an automobile.

Education And Experience

• College degree preferred.
• JD (Law degree) preferred.
• 8+ Casualty claims handling experience (of those, a minimum of 5 years handling cases of a complex nature with a primary P&C carrier).
• Experience with complex commercial GL claims.

Total Rewards

Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and 20 days of paid time off. Additional details about our total rewards package can be found by visiting our benefits page.

The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective’s footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs.

Pay Range

USD 124,000.00 - USD 160,000.00 /Yr.

Additional Information

Selective is an Equal Employment Opportunity employer. That means we respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.

For Massachusetts Applicants: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.