Senior Claims Representative - Legal

Emergent Holdings; United States; On-site; USD 80,900 - 135,400; Full time

Job summary

An established industry player is seeking a Senior Claims Representative – Legal to manage complex litigated claims and collaborate with outside counsel. This role involves negotiating claims, conducting legal research, and providing litigation advice. The ideal candidate will possess a Juris Doctor degree, strong communication skills, and a minimum of five years of experience in claims adjustment or litigation. Join a dynamic team where your expertise will contribute to effective claims management and policy development in the insurance sector.

Qualifications

• Minimum of 5 years experience adjusting commercial claims for an insurance carrier.
• Relevant combination of education and experience may be considered in lieu of degree.

Responsibilities

• Handle negotiations on claims assigned and verify coverage's policy provisions.
• Conduct legal research on pending suit files and assist with negotiations.

Skills

Excellent oral and written communication skills

Excellent presentation and facilitation skills

Ability to analyze coverage submissions

Superior problem-solving ability

Excellent customer service skills

Education

Bachelor Degree from a 4-year college or university

Juris Doctor degree

Admission to the state bar preferred

Tools

Microsoft Office (Word, Excel, Outlook)

Job description

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Job Description

The primary responsibilities of a Senior Claims Representative – Legal include handling negotiations on claims assigned, understanding and verifying coverage's policy provisions, limitations, deductibles, and exclusions, taking statements or interviews when necessary from all parties, coordinating referral of coverage requests, and assigning losses to defense firms and/or independent adjusters as necessary.

Summary

The primary responsibilities of a Senior Claims Representative – Legal include handling negotiations on claims assigned, understanding and verifying coverage's policy provisions, limitations, deductibles, and exclusions, taking statements or interviews when necessary from all parties, coordinating referral of coverage requests, and assigning losses to defense firms and/or independent adjusters as necessary.

Essential Duties and Responsibilities

• Handle suits on third-party litigated claim files, including collaborating with and managing outside counsel and complex litigated claims files as assigned.
• Analyze coverage issues on litigated claim files, and claim files with potential for litigation.
• Assist with negotiations, mediations, arbitrations, and settlement procedures as assigned.
• Attend and provide litigation advice in claim review meetings.
• Coordinate referral with AVP of Claims or VP of Claims on other litigated claims requests to outside counsel.
• Conduct legal research as necessary on pending suit files and as requested by other departments.
• Conduct audits of litigated claims files.
• Review company policy forms as needed.
• Research and write brief opinions on legal issues.
• Recommend reserve and payment changes as necessary for the file.
• Provide and report claims information to Senior Management on an as-needed basis.
• Assist Forms Committee; propose changes/revisions/amendments to company policy forms, make appropriate policy language recommendations, and draft policy language for new forms.
• Other duties as assigned by General Counsel, Sr. Claims Management, or Executive Management.
• Perform other specific duties and projects as assigned.

Education and Experience

Relevant combination of education and experience may be considered in lieu of degree.

• Bachelor Degree from a 4-year college or university.
• Juris Doctor degree.
• Admission to the state bar preferred.
• Minimum of 5 years experience adjusting commercial claims for an insurance carrier or an attorney experienced in litigating or handling insurance claims.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Skills and Abilities

• Excellent oral and written communication skills.
• Excellent presentation and facilitation skills.
• Ability to make competent, independent decisions.
• Ability to analyze coverage submissions and provide assistance.
• Ability to prioritize, organize, and plan work for self and others.
• Excellent customer service skills.
• Superior problem-solving ability.
• Thorough knowledge of claim procedures, policies, terminology, etc.
• Computer proficient with Microsoft Office programs, such as Word, Excel, and Outlook.
• Possess State adjusting license(s) as applicable.
• Ensure assigned files are handled in good faith as defined by statute, case-law, and corporate standards.
• Ability to travel as required.
• Ability to interact professionally with others.
• Sit, stand/walk ambulatory.
• Ability to lift 10 pounds.

Additional Information

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. This job description does not constitute a contract for employment.

Working Conditions & Pay Range

Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $80,900 and $135,400.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Finance and Sales
• Industry: Insurance