Business Title(s): Complex Claims Specialist

Employment Type: Full-Time

FLSA Status: Exempt

Location: In Office - Any employee, in any Clearbrook office, can apply for this opportunity and stay in their current location.

Summary:

We are looking for a highly capable Complex Claim Specialist to join our team and work from our Omaha office. Alternatively, we can fill this position in our Albany office. We work together in the office five days a week in order to strengthen our culture, build team connections, and drive profitability.

The position is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure general liability claims, including some commercial auto 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:

• Working under limited technical direction and within broad limits and authority, adjudicate complex and high exposure third-party general liability bodily injury and property damage claims, potentially with significant impact on departmental results.
• Providing laser-focused customer service to our clients by providing superior claims outcomes and developing meaningful and long-lasting connections with our insured and brokers.
• Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage. 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 promptly and thoroughly to properly 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.
• Adjudicating 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.
• Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Completion of claim evaluations with settlement authority recommendations and present those recommendations to upper management.
• Identifying, assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution.
• Negotiation of claims to a proper resolution within the authority extended. Attend mediations if as and when required. 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.
• Adjudicate 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.
• Having an appreciation and passion for strong claim management.

Qualifications / Experience Required:

• A specialized knowledge of adjudicating complex and high exposure auto bodily injury claims, including fatalities, as well as exceptional customer service focus, typically achieved through:
  • A minimum of five years of experience adjudicating complex and high exposure third-party general liability bodily injury and property damage claims.
  • Bachelor's degree from an accredited university required. Two or more industry designations or four years of relevant experience in addition to those mentioned above can be substituted for a bachelor's degree.
  • Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days
• Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' ability to be profitable).
• Ability to regularly exercise discretion and independent judgment with respect to matters of significance. This role primarily faces problems and issues that are difficult and require an understanding of a broader set of issues.
• A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders by:
  • Finding a way to achieve success through adversity.
  • Being solution (not problem) focused
  • Thinking with a global mindset first.
• Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast-paced environment that is evolving constantly.
• Must have excellent communication skills and the ability to build lasting relationships.
• Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
• Uses listening and questioning techniques to effectively gather information from insureds and witnesses.
• Strong claim negotiation skills a must.
• Knows how claims reserving techniques are used and how to assess whether a claim reserve is accurate.
• Must possess a strong customer focus.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis.
• Proficient in MS Office Suite and other business-related software.
• Polished and professional written and verbal communication skills in order to present information accurately and effectively.
• The ability to read and write English fluently is required.
• Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.

Preferred Qualifications:

• Insurance designations, ACLA, AIC, CCLA, CLMP, CPCU, FCLA, SCLA.
• Working knowledge of Guidewire ClaimsCenter strongly preferred.

The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location.

• Albany Pay Range: $93,228 - $116,994

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.