Complex Claims Specialist (Remote)

Selective Insurance Company of America; United States; Remote; USD 124,000 - 160,000; Full time

Benefits offered by this job

Competitive base salary

Incentive plan eligibility

Health care plans

Retirement plan with company match

Employee Stock Purchase Program

Tuition assistance

20 days paid time off

Job summary

Selective Insurance Company of America is seeking a senior claims professional to directly handle the company’s most complex and challenging claims. The role emphasizes coverage analysis, investigation, evaluation, negotiation, and disposition of assigned claims with strong litigation management to oversee outcomes.

The position requires travel to mediations, arbitrations, and trials up to 20% and collaboration with key stakeholders to ensure compliance with policy and company procedures.

Qualifications

• Experience in complex coverage analysis and significant large loss evaluations.
• Superior communication and strategic negotiation and claim disposition skills.
• Excellent presentation skills and proficiency with standard business software.
• Multi-State licensing; valid driver's license preferred.

Responsibilities

• Effectively evaluate and resolve coverage issues for all lines of business and all liability claim types.
• Investigate claims via telephone, written correspondence, and personal contact with claimants, attorneys, insureds, witnesses and others.
• Effectively manage vendors and expenses.
• Timely analyze information to evaluate claims, determine extent of loss, and arrange medical examinations when necessary.
• Negotiate and resolve claims within delegated authority.
• Provide reports to claims, underwriting, reinsurance, and actuarial on significant exposure cases.
• Report on cases going to trial and attend trials when warranted or requested.
• Ensure referrals and timely updates to reinsurer(s).
• Handle or oversee responses to time-limited, policy limits demand and potential bad faith exposure.
• Travel up to 20% and drive to various locations with a valid license.

Skills

Complex coverage analysis

Large loss evaluations

Negotiation

Communication

Litigation management

Travel readiness

Education

Bachelor's degree

JD preferred

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

PowerPoint

Job description

About Us

At Selective, we don't just insure uniquely, we employ uniqueness.

Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year.

Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.

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 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 responses to time-limited, policy limits demand and threating bad faith or extra contractual exposure 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

Qualifications

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, Work 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 required.
• 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.

• competitive base salary
• incentive plan eligibility at all levels
• comprehensive health care plans
• retirement savings plan with company match
• discounted Employee Stock Purchase Program
• tuition assistance and reimbursement programs
• 20 days of paid time off

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.