Claims Specialist

Job Description

Job Description

Location: Remote

ERGO NEXT's mission is to help entrepreneurs thrive. We're doing that by building the only technology-led, full-stack provider of small business insurance in the industry, taking on the entire value chain and transforming the customer experience. 

Simply put, wherever you find small businesses, you'll find ERGO NEXT.

Since 2016, we've helped hundreds of thousands of small business customers across the United States get fast, customized and affordable coverage. We're backed by industry leaders in insurance and tech, and we still have room to grow — that's where you come in.

As a Claims Specialist, you will be deemed a subject matter expert in the Claims department. Your extensive experience in commercial claims will allow you to handle high-severity and high-complexity claims. You will also lead department roundtables and have the opportunity to serve as a valuable peer resource to other team members!   

What You'll Do:  

• Extensive policy document and legal contract interpretation
• Ability to analyze and identify coverage and related coverage issues
• Leverage a working  knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims
• Manage, investigate, and resolve claims within prescribed authority levels
• Recommend ultimate resolution on assigned cases in excess of authority to claims management
• Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims
• Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues
• Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action
• Preemptively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status reports
• Present file materials for authority and roundtables
• Work with nurses, doctors, and attorneys on file reviews
• Comply with all statutory and regulatory requirements of all applicable jurisdiction
• Meet detailed quality assurance standards and meet set goals for performance
• Set and revise case reserves in accordance with the reserving policy
• Identify potentially suspicious claims and refer to SIU; identify opportunities for third-party subrogation
• Be accountable for the security of the financial processing of claims, as well as security information contained in claims files
• Work with, and provide claim-specific guidance to, independent field adjusters
• Partner closely with internal teams and advise leadership of key claim activities and exposures

What We Need:  

• BS/BA Degree required
• Advanced studies or insurance designation preferred
• At least 10+ years of directly related experience with Commercial General Liability and Litigation
• Strong written and oral communication skills required, as well as strong interpersonal, analytical, investigative, and negotiation skills
• In-depth knowledge of multi-jurisdictional claims handling issues
• Willingness to utilize and adapt to evolving technologies within the Claims operations
• Must be a self-starter and able to work independently
• Candidates must have, or be able to promptly obtain, a Texas Independent Adjuster License 
• Effective communication, presentation, negotiation, and persuasion skills
• Ability to collaborate with cross-functional teams to achieve business results
• Proven success in delivering strong results in a rapidly changing claims environment
• Someone who achieves a standard of excellence with work processes and outcomes, honoring company policies and regulatory compliance
• Team orientation that emphasizes building strong working relationships and contributing to a positive work environment
• High degree of comfort with navigating sometimes ambiguous environments and a willingness to dive in and assist coworkers with workloads or contribute to organizational needs/projects when needed 
• Receptivity to feedback and a willingness to learn, embracing continuous improvement, and having an openness to learning new and evolving proprietary and off-the-shelf software systems
• Some travel capability, likely up to 10% of capability

Note on Fraudulent Recruiting

We have become aware that there may be fraudulent recruiting attempts being made by people posing as representatives of ERGO NEXT Insurance. These scams may involve fake job postings, unsolicited emails, or messages claiming to be from our recruiters or hiring managers. 

The range displayed on this job posting reflects the minimum and maximum target for new hire base salaries for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including, without limitation, job-related skills, experience, and relevant education or training. ERGO NEXT employees are also potentially eligible for our annual performance-based incentive program, in addition to our benefits package, consisting of our partially subsidized medical plan, fully subsidized vision/dental options, life insurance, disability insurance, 401(k), flexible paid time off, parental leave and more.

US annual base salary range for this full-time position:

$100,000—$130,000 USD

Don't meet every single requirement? Studies have shown that some underrepresented people are less likely to apply to jobs unless they meet every single qualification. At ERGO NEXT, we are dedicated to building a diverse, inclusive and respectful workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

One of our core values is 'Play as a Team'; this means making sure everyone has an equal chance to participate and make a difference. We win by playing together. ERGO Next Insurance is an equal opportunity employer and prioritizes building a diverse and inclusive workplace. We provide equal employment opportunities to all employees and applicants of any type and do not discriminate based on race, color, religion, national origin, gender, age, sexual orientation, physical or mental disability, genetic information or characteristic, gender identity and expression, veteran status, or other non-job-related characteristics or other prohibited grounds specified in applicable federal, state, and local laws. ERGO Next's policy is to comply with all applicable laws related to nondiscrimination and equal opportunity and will not tolerate discrimination or harassment based on any of these characteristics. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.