About this role
- As the claims owner, determines coverage, investigates the claims, determines liability, sets and adjusts reserves, evaluates the claim, negotiates a settlement, authorizes and pays the claim; may deny claims.
- Review lawsuit documentation and supporting documents, claims file, investigation, etc.
- Establish actions to be taken to resolve lawsuit.
- Includes determining loss coverage, amounts owed, discovery plans, setting reserves and negotiations.
- Establish appropriate working team (Home Office Legal, Defense Counsel and Home Office Claims) based on allegations established in suit.
- Responsible for managing the practices and billing activities of outside counsel.
- Accountable for security of financial processing of claims, as well as security information contained in claims files.
- Trains and mentors staff as appropriate; manages relationships and acts as liaison with various business partners (e.g., Underwriting, Reinsurance, Etc.).
- Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to specialty coverage issues.
- May analyze the impact upon claims policies and procedures and advises Claims Management so appropriate action can be taken where required.
- Leads and participates in special projects and performs other duties as assigned.
- Advanced to expert knowledge of commercial casualty claims investigation, coverage, reserving, expense management, resolution strategy, negotiation, litigation management, claims evaluation as well as the insurance legal and regulatory environment.
- Advanced to expert level of skill in the area of customer focus, gaining support, teamwork, and adaptability.
- Expert ability to identify and solve problems, achieve results and execute thoroughly.
- Demonstrated ability to work independently, mentor other employees, and serves as a subject matter expert as normally acquired through 7 or more years of experience.
- Ability to adapt to work in multiple claim systems.