Complex Claims Specialist

Company Farm Family Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Summary: The Complex Claim Specialist is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure claims. This includes assessing coverage; contacting the insureds, claimants, and witnesses; engaging experts when needed to fully investigate the facts of the loss and to arrive at a proper conclusion in assessing liability and damages. The Complex Claim Specialist is ultimately responsible for liability and coverage decisions, damage assessments and the negotiation of a claim to conclusion. Handling UM/UIM exposures and reviewing litigation strategy and actions of defense counsel for claims involving Arbitration. Provide the insured with the promise of the policy and excellent customer service. This is a 100% in-office position. Candidates must be able to work on-site at a designated company office during standard business hours. Essential Responsibilities: Completion of an initial review and analysis of the policy coverage to determine if coverage is applicable. Address any excess policies that may be applicable to the loss. Completion of the claim investigation, and/or review of the initial investigation on reassigned files to property assess and evaluate the liability exposure and to ensure proper reserving for a given exposure in accordance with the company’s reserving philosophy. Secure recorded statements from all parties; document file activity in a concise and comprehensive manner. Handling claims that have the greatest complexity and severity, with the highest exposure to the company and to the insured, which may include excess umbrella policies. Completion of claim evaluations with settlement authority recommendations and present those recommendations to upper management. Negotiation of claims to a proper resolution within the authority extended. Attend mediations if as and when required. Additional Responsibilities: Handling all fatality and pedestrian losses. Proactively move files toward a proper resolution. Establish and maintain an appropriate diary on all files. Consult with defense counsel or medical experts if needed. Applies cost containment methodology, when appropriate, claim review for medical necessity and reasonable and customary charges. Utilizing third party bill reviews when applicable. Report to Underwriting when information is developed requiring a risk analysis of the policy. Communicate with agents, providing updates, inquiries and alerts. Process claims according to applicable state mandates/statutes; investigate, review and stay current on applicable case law. Demonstrates responsibility in making liability assessments for first- and third-party losses, send required forms and state compliance documents/letters. Obtain appropriate releases, court approved settlements for minors, or estate claims, structured settlements. Attend pre-suit mediations. Handle demands for Arbitrations and discovery associated with those claims. Ensure compliance with state regulations and requirements. Considers alternative dispute resolutions, utilizing creative resolutions when appropriate, to reach an effective resolution of a dispute. Makes daily decisions to determine the appropriate course of action for the file, considering the exposure of the insured, the company, cost, and risk factors. Qualifications / Experience Required: Bachelor's degree. Six to eight years of experience. Supervisory/management experience not applicable. Completion of the appropriate insurance designation. Training on Medical Terminology. Maintain continuing education (CE) requirements for state licensing. Documented history of successfully handling complex, high exposure claims. Documented proficiency in written and verbal communication. Preferred Qualifications: Insurance designations, AIC, SCLA, CLMP, CPCU. Salary range is $69462 - $92000 PLEASE NOTE: Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas. If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at View phone number on click.appcast.io. Notice to Recruitment Agencies: Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions. We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. The collection of your personal information is subject to our HR Privacy Notice Benefits and Compensation We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program—including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities. Argo and Farm Family are specialty property and casualty insurance brands whose underwriting companies are wholly owned subsidiaries of Clearbrook Holdings Inc. Argo and Farm Family partner with agents and brokers to provide insurance solutions that enable businesses to manage risks with confidence. At Clearbrook our Core Values are Integrity, Collaboration, Pursuit of Excellence and Forward Thinking. These values reflect who we are today and who we aspire to be - guiding how we work, how we lead and how we succeed.