Casualty Claims Specialist

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Requirements:

• Bachelor's degree or equivalent relevant experience.
• Eight years of casualty claims adjusting experience or related experience.
• Relevant insurance designations preferred.
• Superior knowledge of claims practices for complex liability claims.
• Advanced knowledge of insurance contracts and medical terminology.
• Excellent computer and claims systems proficiency.
• Ability to obtain all applicable state licenses.
• Adherence to high standards of professional conduct.
• Exceptional organizational and empathetic interpersonal skills.
• Thorough written and verbal communication skills.
• Advanced customer service abilities.
• Confidentiality maintenance.
• Investigative and problem-solving skills.
• Occasional travel required with valid driver’s license.

Responsibilities:

• Promptly investigates and evaluates claims of severe complexity.
• Reviews claim notice, contracts, and state statutes to verify coverage.
• Investigates complex coverage issues with guidance from coverage counsel.
• Initiates contact with insureds and claimants, explaining the claim process.
• Obtains and documents statements from involved parties.
• Analyzes reports and documents to support claims management.
• Participates in claims discussions to evaluate unique cases.
• Sets adequate reserves according to company philosophy.
• Identifies recovery opportunities, working with legal and investigative experts.
• Meets regulatory requirements with timely communication.
• Collaborates with defense counsel on litigation strategy.
• Resolves questions of coverage and value with timely communication.
• Reviews Medicare liens per company guidelines.
• Ensures accuracy in settlement documents and vendor estimates.
• Mentors team members and provides technical resources.
• Leads and participates in claims projects.