Senior Complex Loss Specialist

Integrated Specialty Coverages, LLC; United States; Remote; USD 87,000 - 109,000; Full time

Benefits offered by this job

Employee Ownership Program

Owner Referral Program

Work from home reimbursement

Canary emergency financial assistance

Job summary

Integrated Specialty Coverages, LLC (ISC) is seeking a Complex Loss Specialist to adjust high-exposure, time-intensive claims within the ISC program. This role reports to a Claims Supervisor or Manager and requires deep technical knowledge and negotiation skills.

The position involves reserving, coverage analysis, litigation management, and presenting findings to executives, with starting pay in the national range of $87,000–$109,000 USD and comprehensive benefits.

Qualifications

• Minimum of 10 years of claims experience, with an emphasis on complex claims.
• College degree or equivalent claims management experience required.
• 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.
• Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact.

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
• Healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures
• Coverage analysis and interpretation of policies, including review of coverage dates, limits, exclusions, and endorsements
• Drafting reservation of rights letters and coverage denial communications for supervisor review
• Reserve evaluation, setting, and recommendation based on exposure analysis and claim trajectory
• Litigation management, including assignment and direction of defense counsel, independent medical examiners, and expert witnesses
• 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 experience

Claims management

Litigation management

Licensing (adjuster)

MS Office proficiency

Communication

Education

College degree or equivalent

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Integrated Specialty Coverages, LLC (ISC) is seeking a Complex Loss Specialist to adjust high-exposure, time-intensive claims within the ISC program. This role reports to a Claims Supervisor or Manager and requires deep technical knowledge and negotiation skills.

The position involves reserving, coverage analysis, litigation management, and presenting findings to executives, with starting pay in the national range of $87,000–$109,000 USD and comprehensive benefits.