AVP- Complex Claim Specialist

Claim Specialist

Investigate, evaluate, reserve, negotiate and resolve the companys most severe and / or complex claims, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management.

Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, negotiating and resolution. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This may include a specific assignment as a severity management resource to one or more field offices.

What Will You Do?

• Claim Handling :
• Directly handle the Companys most severe and complex claims when Travelers has coverage of $2 million or greater and file exposure is greater than $2 million.
• Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.
• Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
• Complete outside investigation as needed per case specifics.
• Actively engage in the identification, selection and direction of appropriate internal and / or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants and fire or fraud investigators and other experts.
• Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
• Utilize diary management system to ensure that all claims are handled timely.
• At required time intervals, evaluate liability & damages exposure.
• Establish and maintain proper indemnity & expense reserves.
• Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.
• Apply the Companys claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.
• Develop and employ creative resolution strategies.
• Effectively and efficiently manage both allocated and unallocated loss adjustment expenses
• Evaluate all claims for recovery potential; directly handle recovery efforts and / or engage and direct Company resources for recovery efforts.
• Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives.
• Ensure that the right resources are being applied to each claim to achieve the best result at the most optimal cost.
• Leadership :
• Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
• Field Severity Support : Some Complex Claim Specialists may be responsible for all or some of the following :
• Collaborate with field severity units in the management and evaluation of some of the Companys severe and complex liability claims by providing claim handling guidance, recommendations and strategies to Field Product Line Managers, Unit Managers, and Major Case Specialists, for timely, cost effective resolution of liability major cases.
• Provide mentoring or training as request by field severity management.
• Consult with Manager on use of Claim Coverage Counsel as needed.
• Provide guidance to underwriting business partners with res accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
• Recommend appropriate cases for discussion at roundtable.
• Attend and or present at roundtables / authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
• Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
• Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws.
• Obtain and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.
• Assist underwriting business partners in marketing and account-contact.
• Actively participate in the coverage, liability and damages analysis and development of creative resolution strategy for severity cases handled in the field.
• Assist in the recognition of available defenses to contain loss payout and setting of appropriate reserves.
• Regularly and actively participate in field severity roundtables to share expertise and recommendations in all aspects of severe claim management.
• Collaborate with the severity unit in compliance with company claim policies, procedures, practices and standards for the handling of cases that meet the Critical Claim referral guidelines.
• Other responsibilities :
• Apply expert litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
• Recognize and implement alternate means of resolution.
• Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.
• Track and control legal expenses to assure cost-effective resolution.
• Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.
• Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Closely monitor independent counsel to ensure quality product.
• Actively participate in periodic file quality reviews.
• Appropriately deal with information that is considered personal and confidential.
• Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

What Is a Must Have?

What Is in It for You?