Senior Claims Specialist

We are currently seeking a dynamic individual to join our team as a Senior Claims Specialist with in-depth experience and liability claim knowledge addressing bodily injury, negligence, wrongful death and other casualty-styled claims within the assisted living and nursing home arena.

Job Description:

The Senior Claims Specialist will:

• Handle complex litigated and non-litigated assisted living and nursing home claims across the United States. This would include investigating, evaluating, and resolving claims and lawsuits of a more severe and complex nature.
• Investigate all aspects of assigned claims from cradle to grave including coverage determination, resolving informally postured claims directly, working with defense counsel where defense obligation exists, issuing reservation of rights letters where coverage does exist, issuing coverage declinations when coverage does not exist, responding to push backs or rebuttals if received.
• Manage a pending of non-litigated, litigated and coverage files within industry and client guidelines.
• Comply with all statutory and regulatory requirements in all applicable jurisdictions.
• Thoroughly investigate, review information/documentation received, identify key issues and plan of action required, conduct a thorough analysis of liability, injury and damages, negotiate covered claims to resolution, and able to input and review notes/diaries into claims management system.
• Follow client-specific requirements for reporting, vendor assignment, reserve and settlement authority and control loss adjustment expenses.
• Ability to guide and control litigation with an eye towards early resolution.
• Attend and participate in mandated case or claim-related events including court, mediation and arbitration proceedings.
• Periodic travel, including air travel to: investigate/handle claims, engage in client meetings, attend audits/file reviews, and participate in staff meetings or training sessions.
• Select and manage defense and coverage counsel, investigators, field adjusters, vendors and expert witnesses within company and/or client guidelines, and ensure that company resources with regard to same are utilized in a cost effect manner in the process.
• Determine if subrogation opportunity exists and takes steps to initiate recovery efforts.
• Handle regulatory reporting for Medicare and Reinsurance

You Are Someone with:

• Self-direction, self-motivation, independent and analytical thinking skills
• Familiarization with state insurance regulations for all 50 states but predominantly handling claims in southern and southeastern states
• Superior track record in all aspects of claims handling and resolution. Strong coverage and negotiation skills a must
• Strong collaboration skills to work with internal and external team members in driving the claims process
• Self-starter with the ability to drive work streams and analyses
• Ability to work in a fast-paced environment and under pressure
• Strong working knowledge of Microsoft Office suite of products including Outlook, Word, Excel and Power Point
• Strong communication (written/verbal) and presentation skills
• Bachelor’s Degree, home state license required
• Nursing home and assisted living claim handling experience required
• 10 years minimum experience preferred
• Advanced litigation management skills
• Ability to be licensed and bonded for state insurance licenses as needed

Competitive compensation and benefit package including health, dental, life insurance, 401k plan with match.

Primary Location Preference: Texas