Litigation Claims Adjuster - Complex

200 CRC Insurance Svcs LLC; North Carolina; Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life and disability insurance

401(k) with company match

Paid time off

Job summary

CRC Group is seeking a Senior Claims Professional in the United States to manage complex claims processes, including investigation, evaluation, and resolution of high-severity claims. The role emphasizes timely adjudication, risk reduction, and strong client/broker relationships.

Responsibilities include collaboration with legal counsel, underwriters, and vendors; preparation of detailed claim decisions; and leadership in compliance and process improvements within the claims department.

Qualifications

• Bachelor’s degree in business, insurance, risk management, or related field preferred.
• 5+ years of experience handling claims, preferably in specialty or complex lines.
• Experience working with brokers, legal professionals, and regulatory agencies.

Responsibilities

• Investigate, assess, and resolve complex claims within authority limits.
• Analyze policy coverage and liability to determine appropriate claim outcomes.
• Develop and execute strategies to mitigate potential financial risk exposure.
• Collaborate with legal counsel, underwriters, and external vendors as necessary.
• Prepare comprehensive reports and documentation for claim decisions.
• Ensure all regulatory requirements and compliance standards are met.
• Manage communications with clients, brokers, and internal stakeholders throughout the claims process.
• Participate in audits and quality control reviews to ensure best practices.
• Contribute to process improvement initiatives within the claims department.

Skills

Advanced claims analysis

Negotiation and settlement

Communication

Policy interpretation & compliance

Mentoring

Claims systems proficiency

Education

Bachelor’s degree in business, insurance, risk management, or related field

Tools

Claims management systems

Job description

Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America)

Please review the following job description: The Claims Senior Professional manages complex claims processes, including investigating, evaluating, and resolving high-severity claims in compliance with company standards and regulations. This role ensures timely adjudication while minimizing risk exposure and maintaining superior customer and broker relationships.

KEY RESPONSIBILITIES

• Investigate, assess, and resolve complex claims within authority limits.
• Analyze policy coverage and liability to determine appropriate claim outcomes.
• Develop and execute strategies to mitigate potential financial risk exposure.
• Collaborate with legal counsel, underwriters, and external vendors as necessary.
• Prepare comprehensive reports and documentation for claim decisions.
• Ensure all regulatory requirements and compliance standards are met.
• Manage communications with clients, brokers, and internal stakeholders throughout the claims process.
• Participate in audits and quality control reviews to ensure best practices.
• Contribute to process improvement initiatives within the claims department.

EDUCATION AND EXPERIENCE

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Bachelor’s degree in business, insurance, risk management, or related field is preferred.
• 5 or more years of experience handling claims, preferably in specialty or complex lines.
• Demonstrated expertise in managing complex or high-risk claims scenarios.
• Experience working with brokers, legal professionals, and regulatory agencies.

CERTIFICATIONS / LICENSES / REGISTRATIONS

• Must hold and maintain all required licenses in all U.S. states where licensing is required to perform the duties of this position.
• Insurance-specific certifications (e.g., AIC, CPCU) are preferred.

FUNCTIONAL SKILLS

• Advanced claims analysis and adjudication techniques.
• Strong negotiation and settlement skills.
• Excellent written and verbal communication abilities.
• Proficient in policy interpretation, risk assessment, and regulatory compliance.
• Ability to mentor and provide guidance to less experienced team members.
• Proficiency with claims management systems and related technology platforms.

General Description of Available Benefits for Eligible Employees of CRC Group

At CRC Group, we're committed to supporting every aspect of teammates' well-being – physical, emotional, financial, social, and professional.

Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support.

Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match.

CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more.

Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan.

CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law.

CRC Group is a Drug Free Workplace.

EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify Join CRC Group, a leader in specialty wholesale insurance, and take your career to new heights. We're a dynamic team dedicated to innovation, collaboration, and excellence.

Why CRC Group?

• Growth: Advance your career with our learning and leadership development programs.
• Innovation: Work in a forward-thinking environment that values new ideas.
• Community: Be part of a supportive team that celebrates success together.
• Benefits: Enjoy competitive compensation, health benefits, and retirement plans.

Who We’re Looking For

We seek passionate individuals who thrive in a fast-paced, collaborative environment. If you value integrity and are driven to succeed, CRC Group is the place for you.