The Claims Senior Professional manages complex claims processes, including investigating, evaluating, and resolving high-severity claims in compliance with company standards and regulations. This role ensures timely adjudication while minimizing risk exposure and maintaining superior customer and broker relationships.

KEY RESPONSIBILITIES:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
• Investigate, assess, and resolve complex claims within authority limits.
• Analyze policy coverage and liability to determine appropriate claim outcomes.
• Develop and execute strategies to mitigate potential financial risk exposure.
• Collaborate with legal counsel, underwriters, and external vendors as necessary.
• Prepare comprehensive reports and documentation for claim decisions.
• Ensure all regulatory requirements and compliance standards are met.
• Manage communications with clients, brokers, and internal stakeholders throughout the claims process.
• Participate in audits and quality control reviews to ensure best practices.
• Contribute to process improvement initiatives within the claims department.
EDUCATION AND EXPERIENCE

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Bachelor's degree in business, insurance, risk management, or related field is preferred.
• 5 or more years of experience handling claims, preferably in specialty or complex lines.
• Demonstrated expertise in managing complex or high-risk claims scenarios.
• Experience working with brokers, legal professionals, and regulatory agencies.
CERTIFICATIONS / LICENSES / REGISTRATIONS
• Must hold and maintain all required licenses in all U.S. states where licensing is required to perform the duties of this position.
• Insurance-specific certifications (e.g., AIC, CPCU) are preferred.
FUNCTIONAL SKILLS
• Advanced claims analysis and adjudication techniques.
• Strong negotiation and settlement skills.
• Excellent written and verbal communication abilities.
• Proficient in policy interpretation, risk assessment, and regulatory compliance.
• Ability to mentor and provide guidance to less experienced team members.
• Proficiency with claims management systems and related technology platforms.

General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan.