Senior Complex Claims Strategist

ISC (Integrated Specialty Coverages, LLC); San Diego (CA); Hybrid; USD 87,000 - 109,000; Full time

Benefits offered by this job

Employee Ownership Program

Owner Referral Program

Work from home reimbursement

Health Savings Account

401(k) Plan with company match

Job summary

Integrated Specialty Coverages, LLC (ISC) seeks a Complex Loss Specialist for its Golden State Claims Services unit in the United States. This role focuses on adjusting the most time-intensive, complex, and high-exposure losses with advanced technical expertise.

You will present analyses to senior executives, lead strategic roundtables, and collaborate with underwriting, service teams, clients, and agents to determine optimal resolutions.

Qualifications

• Minimum of 10 years of claims experience, with an emphasis on complex claims.
• College degree or equivalent claims management experience.
• Minimum of 10 years litigation management experience preferred.
• Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed.
• Proficient computer skills including Microsoft Outlook, Word, and Excel.

Responsibilities

• Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives.
• Building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams, and agents
• Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions
• Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager
• Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc.
• Document activities in writing within claim files
• Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier.
• Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts.
• Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager
• Evaluate, set, or recommend reserves for each file they are handling.
• Prepare written reports as dictated by company policy and procedures.
• Handle claims within guidelines of the Fair Claims Practices 790.03
• Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling.
• Discuss unique and complex files with Supervisor/Manager
• Securing recorded and written statements from insureds, claimants, and witnesses
• Gathering and organizing supporting documentation including incident reports, medical records, licensing records, contracts, and expert reports
• Maintaining accurate, detailed claim file documentation in compliance with carrier and program guidelines
• Preparing written reports and roundtable summaries consistent with company policies and procedures

Skills

Complex claims

Teamwork

Communication

Negotiation

Analytical thinking

Education

College degree or equivalent

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Integrated Specialty Coverages, LLC (ISC) seeks a Complex Loss Specialist for its Golden State Claims Services unit in the United States. This role focuses on adjusting the most time-intensive, complex, and high-exposure losses with advanced technical expertise.

You will present analyses to senior executives, lead strategic roundtables, and collaborate with underwriting, service teams, clients, and agents to determine optimal resolutions.