Claims Specialist

other locations Chicago and Plano- Dallas Texas Duration: 12+ Months The Opportunity The purpose of this role is to oversee the examination, evaluation, and processing of complex Claims estimates and paid Claims values, ensuring adherence to policy terms and conditions in alignment with the Client Claims Philosophy. The role also entails supporting the claims function in specific insurance classes to drive operational efficiency, efficient claims settlement, and fair resolution of claims disputes in line with company guidelines and philosophy. The selected candidate will manage the complete investigation, evaluation and resolution of assigned portfolio of complex claims emanating the lawyers professional and miscellaneous professional liability business segments, Engages, directs and manages external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants across highly complex portfolio of matters. Your new role Manage a diverse portfolio of complex claims which includes conducting fact, liability and loss investigations and interpreting insurance contracts in an effective and efficient manner Evaluate and negotiate the resolution of assigned claims in a timely manner, within appropriate authority and in accordance with applicable laws, regulations, statutes, best practices and Department of Insurance (DOI) compliance Drive the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to deliver superior claim outcomes Collaborate with outside representative counsel to formulate litigation strategy ensuring achievement of desired outcome and effective litigation management strategies Directs and manage external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants. Oversee projects and planning surrounding departmental initiatives to achieve strategic objectives Analyze, develop and determine appropriate case reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy Advise on specific professional liability areas of specialization and coordinates efforts to disseminate information and guide learning and thought leadership in those areas; serve as the subject matter expert Represent Client by participating in and attending industry seminars or authoring articles pertaining to professional liability subjects Collaborate with Underwriters to identify, understand and address Client or complex risks to appropriately price and negotiate terms including participation in sales calls and requests for proposals (RFPs) Manage relationships with external vendors to deliver accurate, timely, and cost-effective solutions. Take ownership for personal development and career planning, and development of required skills, tools, techniques, and technology to continually add value to the organization. Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility Required Education Bachelor's Degree or equivalent combination of education and work experience Required Experience 8 years relevant experience Generate original, innovative solutions to difficult or unusual situations Identify and locate information and facts which are necessary and relevant for the purposes of evaluating a claim Financial and business acumen and awareness of financial responsibility Quickly change direction when working on multiple projects or issues Properly document investigation findings and preserve evidence in accordance with internal and external laws and procedures Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems Assume a methodical approach to a given situation and develop a systematic procedure as a response Develop effective negotiation strategies and prepare a plan of action Build and capitalize on beneficial internal and external relationships including competitors Actively contributes towards continuously improving performance and mentor team with feedback, on-the-job skill enhancement opportunities and career advice Build and establish constructive and cooperative working relationships and open lines of communication Utilize effective communication skills to influence and persuade decision makers Manage a diverse and extensive portfolio of management and professional liability claims with varying levels of complexity and activity. Collaborate with internal resources to resolve difficult claims situations and drive resolution opportunities with internal and external stakeholders #J-18808-Ljbffr SANS Consulting Services, Inc.