Technical Claim Specialist

Job description

BASIC PURPOSE: Responsible for handling large, complex casualty claim files, including litigated matters, umbrella claims and severe injury claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense attorney. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives. QUALIFICATIONS: - Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle all claims in accordance with state and federal laws. - Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner. Deny losses within authority level, providing detailed explanation, citing facts, and policy language. - Perform a thorough investigation based upon the type, complexity, and severity of the claim. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the potential high exposure and extensive damages, including potential full or partial liability and compensability denials. Formulate and docume...