Senior Complex Claims Adjuster

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

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.