Position Summary: The Claims Executive is responsible for accurate reporting and filing of claim litigation to the respective carrier, in addition to handling complex claims scenarios along with resolution of claims disputes. The Claims Executive functions as an insurance claims professional that provides guidance to the customers and producers on more complex claims issues. The Claims Executive is responsible for monitoring the assigned inventory of accounts, answering phone calls, consulting on claims-related issues. Duties include handling customer service calls as needed and reviewing claims on an as‑needed basis.
Essential Tasks
- Reports to the Claims Operations Manager on workflow issues and the handling of assigned claims inventory.
- Serves as the point of contact for assigned threshold accounts.
- Reviews policy language and offers a professional opinion regarding coverage, settlements, reserve practices, etc.
- Handles and works with carrier and client on professional coverages, including D&O and EPL.
- Troubleshoots and consults clients on all P&C lines, including disputes or denials by the carrier.
- Reviews, documents, and acknowledges pre‑litigation requests or demands.
- Is able to understand reports, monitor, and consult clients on any litigation claims brought to suit.
- Proficient in Excel with the capability to produce charts and presentations.
- Performs claims reviews and loss analysis for assigned threshold accounts.
- Is comfortable with presentations to prospects and existing clients.
- Travels as needed to support existing clients as well as company growth goals.
- Works both in a team environment and independently with minimal supervision.
- Has excellent time‑management skills with the ability to multi‑task and calendar client service plans.
- Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction.
- Performs other related duties as assigned.
Core Competencies
- Ability to analyze and solve problems: skill in recognizing challenges, exploring options, and implementing effective solutions in a timely manner.
- Attention to detail: a strong focus on completing tasks and projects accurately and thoroughly.
- Communication skills: capably expresses ideas clearly in both verbal and written forms and engages with various audiences.
- Timely task completion: ability to finish tasks and projects efficiently, managing resources and priorities effectively.
- Team collaboration: willingness to work together with others, promoting teamwork and supporting shared goals.
- Client focus: dedication to understanding and addressing the needs of clients and stakeholders to ensure their satisfaction.
- Dependability: acknowledgment of the importance of being present and punctual.
- Creative thinking: openness to suggesting new ideas and methods to improve processes and outcomes.
- Organizational skills: capability to prioritize tasks and manage multiple projects simultaneously.
- Adaptability: willingness to adjust to changing situations and priorities, showing resilience in a dynamic work environment.
Experience and Education
- Bachelor’s degree and at least 5 years of experience in the related field.
- 3+ years of claims processing experience.
- Knowledge of insurance claims terminology.
- Proficient with claims processing guidelines, working knowledge of claims settlement and insurance claims practices.
- Ability to organize, prioritize, and communicate effectively while meeting deadlines and production goals.
- Commonly‑used knowledge of claims examination concepts, practices, and rules and claims workflows; this position utilizes experience and judgment to plan, accomplish goals, and effectively solve problems with a variety of scenarios.
- Advanced training in claims processes preferred.
Licensing and Credentials
- Adjusters license.
- Previous litigation and insurance claims experience preferred.
Systems
- Proficient with Microsoft Excel, Word, PowerPoint, and Outlook.
- Applied Epic experience preferred, but knowledge of a similar account management system (AMS) is acceptable.
Physical Requirements
- Ability to lift 25 pounds.
- Repeated use of sight to read documents and computer screens.
- Repeated use of hearing and speech to communicate on telephone and in person.
- Repetitive hand movements, such as keyboarding, writing, 10‑key.
- Walking, bending, sitting, reaching, and stretching in all directions.