Sr Casualty Claims Specialist

7 days ago

Cedar Rapids, United States United Fire & Casualty Full time

UFG is seeking a Senior Casualty Claims Specialist to be primarily responsible for investigating, evaluating, negotiating, and settling complex E&S casualty claims. The Senior Casualty Claims Specialist demonstrates strong technical abilities and industry knowledge to make complex claim decisions. They are subject matter experts for coverage analysis, risk transfer, AI, tenders, liability analysis, reserve evaluation, settlement evaluation and negotiation strategy. They mentor other claim handlers, provide technical insight to their teams, and participate in special projects.

Responsibilities:

  • Review assignments to determine the nature of the claim and action required as well as coverages involved. Make telephone contact with insureds or claimants within 24 hours.
  • Conduct detailed investigations to include taking recorded statements from insureds, claimants, witnesses and others possessing facts concerning the claim. Securing relevant evidence including but not limited to police reports, pictures, video, audio transcriptions, social media, etc. Vet and retain necessary experts to detail the facts of the loss, while managing adjusting expense.
  • Review and interpret policy coverages to determine whether the claim is payable under the policy. If coverage issues are present draft and send a Reservation of Rights letter to the policyholder.
  • Write reports for the claim file to document all activity relating to the loss. Inform underwriting if increased hazards or unusual circumstances concerning a risk/policy exposure. Discuss problems with supervisor. Maintain necessary records for reference and diaries. Answer phone inquiries from agents, insureds, claimants, contractors, and repair facilities.
  • Compile and review information concerning losses from various sources, medical records, wage information as well as reports from police and fire departments. Determine negligence in liability claims and extent of injury or possible malingering of claimants. Determine/evaluate damages. Evaluate information gathered to determine the realistic value of the loss.
  • Follow reserving philosophy of realistic value x liability + 4% for unforeseen circumstances. Meet reserve timeliness, accuracy, and adequacy guidelines.
  • Be constantly aware of the expense factor in claims handling and expense management initiatives.
  • Contact insureds, claimants, or legal counsel to negotiate settlements, obtain releases and issue checks.
  • Attend mediations on non-litigated or litigated (conflict) files.
  • Engage attorneys as needed for coverage or defense.
  • Actively pursue subrogation claims with the insurance carrier or uninsured wrongdoer to recover funds due to the company and insured. Work with subrogation unit on more complicated files.
  • Keep up to date concerning recent court cases, changes in the law, and new medical techniques. Keep resource materials updated.
  • Promotes positive working relationships with agents in the territory by keeping the producing agent informed of progress on claims.
  • Participate in company sponsored educational programs to develop and maintain knowledge of products, procedures, and industry trends.
  • Handle complex non-litigated casualty claims.
  • Handle litigated files that are ripe for negotiation and push towards resolution, rather than further discovery and litigation.
  • SME for coverage analysis, risk transfer, AI, tenders, liability analysis, reserve evaluation, settlement evaluation and negotiation strategy.
    • Mentors other claim handlers to further their development and skills.
    • Provides technical training to their teams.
Qualifications:

Education:
  • 4-year college degree preferred.
Certifications/Designations:
  • CPCU, AIC, SCLA or Legal Principles, CCLA and PCLA of the AEI series, or to be completed in 3 years.
  • Meet the appropriate state licensing laws required to handle "multi line" claims.
Experience:
  • 7+ years' experience in handling casualty claims to function properly in position.
Working Conditions:
  • General office environment.
  • Frequently the job requires working irregular hours.
  • Occasional overnight travel and weekend hours may be required.
Knowledge, skills & abilities:

Knowledge of:
  • UFG Billing guidelines.
  • Various lines of policy coverages, contract law, and indemnification issues
  • Civil procedure
  • Applicable statutes and case law
  • Negligence Laws
  • Unfair claims practices/bad faith
  • Fraud indicators
  • Understanding of the venue
  • Complex injuries and impact on case value
  • Applicable building codes and/or regulations
  • Direct negotiation and alternate dispute resolution techniques
Skills:
  • Highly skilled in GLBI exposures and risk transfer.
  • Collaboration
  • Continuous improvement
  • Influence and Persuade
  • Advocate and Promote
  • Instill Trust
  • Ability to conduct a strong independent analysis and proactively driving claims towards resolution.
  • Polished presentation skills and ability to present and articulate claims to committee.

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