Multi-line Complex Claims Manager

Position Overview

To manage complex and high-dollar reinsurance multiline claims (Liability, Workers’ Compensation and Property) within multiple jurisdictions. Monitor the claims handling performance of members and third-party administrators.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Claims Management

• Perform timely and accurate processing of multi-line claims in multiple jurisdictions.
• Adhere to best practices for reinsurance claims handling.
• Conduct coverage verification and complete complex coverage forms.
• Monitor the performance of members and third parties and take appropriate action as required.
• Make accurate and timely payments.
• Estimate loss reserves for reinsurance claims.
• Monitor reserve adequacy and update as needed based on claim developments.
• Obtain reinsurance recoveries where applicable.
• Maintain detailed records of claims, including relevant documentation, correspondence, and settlement details.

Assessment

• Review and analyze reinsurance claims submitted by ceding companies. Evaluate coverage, policy terms, and loss details to determine validity and compliance with reinsurance agreements.
• Review and analyze contracts and related claim documents.
• Participate in audits of claims processes and procedures. Identify areas for improvement and adhere to best practices.
• Work closely with cross-functional teams, including Members, the CRL board, underwriting, legal, actuarial, and finance, to ensure seamless claims resolution.
• Work directly with CRL members on claim-related issues and manage escalations.
• Collaborate with underwriters to assess potential exposures and mitigate risks.

Compliance

• Ensure compliance with regulatory requirements, industry guidelines, and internal policies.
• Stay informed about industry developments and adjust processes accordingly.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Travels as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree preferred.Associate in Risk Management (ARM) and/or other risk management designations preferred.

Experience

• Seven (7) plus years of property/casualty and/or workers' compensation experience or equivalent combination of education and experience required Two (2) years plus of managing complex claims required.
• Knowledge of reinsurance principles and practices preferred.
• Experience with manuscript coverage preferred.
• Experience with public entity pools is preferred.
• Riskonnect experience preferred.

Skills & Knowledge

• Understanding of the rating methodology of workers’ compensation, property, and liability insurance coverage(s). Ability to reason, solve practical problems, and interpret a variety of information and instructions.
• Ability to reason, solve practical problems, and interpret a variety of information and instructions.
• Analytical and interpretive skills with strong attention to detail.
• Excellent oral and written communication skills, including presentation skills.
• Proficiency in working effectively in a team environment, when working independently and when working offsite or remotely.
• Proficiency in Microsoft Office applications, including Word and Excel, and claims management systems.
• Excellent negotiation and communication abilities.
• Ability to meet or exceed Performance Competencies.
• Ability to develop and maintain effective working relationships with all levels of the organization, members and third parties.
• Proficiency in working effectively in a team environment, when working independently and when working offsite or remotely.

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to a reasonable accommodation.

Mental

Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical

Computer keyboarding, travel as required

Auditory/Visual

Hearing, vision and talking

Location

North Carolina (Hybrid options available after 6 months)

NOTE

Credit security clearance, confirmed via a background credit check, is required for this position.

County Reinsurance Limited is an Equal Opportunity Employer and a Drug-Free Workplace.

The above is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for this job's performance. It is not to be construed as an exhaustive statement of all supplemental duties, responsibilities, or nonessential requirements. The Company has the right to change, modify, suspend, interrupt, or cancel in whole or in part any job functions outlined in a job description at any time and without advance notice to the employee.