Senior Complex Claims Specialist
The Senior Complex Claims Specialist investigates, evaluates, negotiates, and resolves complex and high-exposure litigated and non-litigated claims across bodily injury, property damage, personal and advertising injury, and professional liability lines.
• Analyze coverage, identify coverage issues, and prepare coverage letters for supervisor approval
• Investigate and evaluate liability
• Investigate and evaluate damages
• Manage litigation by assigning counsel from the approved panel where applicable, establishing litigation plans and budgets, coordinating with defense counsel, and continuously reviewing the potential for resolution
• Establish timely reserves within authority and re-evaluate throughout the life of the claim
• Maintain up-to-date, appropriate file documentation and written file notes
• Maintain an active diary and productive file inventory
• Timely complete all required large loss reporting
• Negotiate settlements within authority limits and attend mediations, Mandatory Settlement Conferences, and/or Alternative Dispute Resolutions
• Proactively control the work product and expense of outside vendors
• Develop and maintain positive customer relationships and provide superior customer service
• Timely identify all potential opportunities for co-insurance, transfer of risk, and/or subrogation
• Work with designated assigned accounts
• Recognize and investigate fraud
• Comply with deductible/self-insured retention recovery protocol
• Meet all State licensing requirements
• Adhere to all statutory regulations, Unfair Claims Practices acts, and corporate Best Practices
• Serve as mentor for claims associates and provide technical advice
• Assist management with administrative tasks as needed
• Perform other duties as assigned
Qualifications
• Eight (8) or more years of claims handling experience or equivalent experience
• In-depth knowledge of the insurance industry, including legal and regulatory environments
• Specific knowledge and expertise in New York Labor law and construction-related claims (preferred)
Education Requirement
• Four (4) year college degree, or commensurate experience and training
• JD preferred
• Industry designations preferred (e.g., CRIS, AIC, SCLA)
• New York adjuster's license a plus