Senior Claims Specialist

Senior Claims Specialist

To handle single and multi-party personal or commercial line claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

Job Qualifications Required:

• Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.
• Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.
• Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area.
• Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.
• High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.
• Must obtain and maintain required adjuster license(s)
• Microsoft Office experience
• Knowledge of insurance regulations, markets and products

AND

• Must obtain and maintain required adjuster license(s)
• Microsoft Office experience
• Knowledge of insurance regulations, markets and products

Preferred:

• Effective verbal and written communication skills
• Strong analytical, critical thinking and problem-solving skills
• Strong multi-tasking and prioritization skills
• Experience collaborating in a team environment and building cross functional working relationships
• Proactively shares and promotes sharing of insights
• Ability to gather unique perspectives from other teams/functions to optimize outcomes.
• Understands, analyzes, and applies the component parts of an insurance policy for complex claims
• Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
• Ability to determine the scope and exposure for complex claims
• Ability to leverage trend and relationships to provide high-quality customer service
• Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
• Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
• Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies

Job Accountabilities - Key Accountabilities:

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.
• Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
• Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
• Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Meet quality standards by following best practices

Job Functions:

• May participate in customer marketing efforts.

Business Accountabilities:

• Lead a team of claims handling specialists to develop and implement business processes and manage performance across all activities in order to achieve business objectives and continuously improve performance.
• Translate business objectives into clearly defined business cases, costs or schedules in order to support the achievement of claims.
• Monitor and control allocated human and material resources assigned to project work, maintaining financial and progress forecasting in order to ensure projects are delivered according to schedule and within budget.
• Supervise and quality-assure the drafting of key claims handling policy documents to ensure full compliance to the organization's rules and regulations governing transactions.
• Oversee compliance with claims policies, procedures, systems and processes across multiple countries/Line of Business to protect the organization's interests.
• Analyze key themes from a wide range of data sources in order to identify trends and areas for business improvement providing potential solutions.
• Contribute to the development of process and lead the implementation of systems and process improvements in claims handling.
• Provide technical guidance and recommendations as a subject matter expert in order to support the resolution of the most complex customer cases and develop precedents to improve customer service.
• Manage key internal and external stakeholder relationships across the organization in order to ensure colleagues are informed on relevant issues.
• Act as a technical expert for own team and internal customers and maintains up to date knowledge of own area of expertise so that operational claims team can best serve customers.