Complex Claims Specialist

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