Claims Specialist

BS/BA Degree required Advanced studies or insurance designation preferred At least 15+ years of directly related experience with Commercial General Liability and Litigation Strong written and oral communication skills Strong interpersonal, analytical, investigative, and negotiation skills In-depth knowledge of multi-jurisdictional claims handling issues Willingness to utilize and adapt to evolving technologies Must be a self-starter and able to work independently Candidates must have, or be able to promptly obtain, a Texas Independent Adjuster License Effective communication, presentation, negotiation, and persuasion skills Ability to collaborate with cross-functional teams Proven success in delivering strong results in a rapidly changing claims environment Achieves a standard of excellence with work processes and outcomes Team orientation High degree of comfort with navigating ambiguous environments Receptivity to feedback and willingness to learn Some travel capability, likely up to 10%

Extensive policy document and legal contract interpretation Analyze and identify coverage issues Manage, investigate, and resolve claims Recommend ultimate resolution on assigned cases in excess of authority Drive litigation, attend mediations, trials, and ADR Communicate with policyholders, witnesses, and claimants Respond to written and telephone inquiries Present file materials for authority and roundtables Work with nurses, doctors, and attorneys on file reviews Comply with all statutory and regulatory requirements Meet quality assurance standards and performance goals Set and revise case reserves Identify suspicious claims and referral opportunities Accountable for security of financial processing and claim files Work with and provide guidance to independent field adjusters Partner with internal teams and advise leadership