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Senior Claims Specialist

2 months ago

Montpelier, Vermont, United States Vermont Mutual Full time
Job Overview

Position Summary

The Senior Claims Specialist is responsible for managing a varied caseload of claims that encompass multiple coverage types and a significant proportion of moderate complexity and financial impact. The claims may occasionally involve intricate coverage matters or legal disputes. The ideal candidate will have proven expertise in handling substantial bodily injury claims, particularly those involving comparative negligence theories and defenses.

Key Responsibilities

  • Conduct thorough investigations for all assigned claims.
  • Negotiate settlements within authorized limits while maintaining accountability for each claim until resolution.
  • Advise on claims that exceed authority limits for further action.
  • Document all activities related to assigned claims and manage independent vendors effectively.
  • Review new claims and monitor existing files to ensure adequate reserves, keeping management updated on any adverse developments.
  • Control loss adjustment expenses and manage costs associated with third-party service providers.
  • Utilize vendors effectively to maximize service value.
  • Interpret coverage questions and seek approval from the Claims Supervisor.
  • Refer significant coverage issues to the Claims Supervisor or Claims Manager.
  • Ensure compliance with file handling, documentation, and expense control, including MSP regulations.
  • Provide accurate and timely information to both internal and external customers regarding claim status and inquiries.
  • Present detailed reports and facilitate discussions on claims requiring peer and management review.
  • Engage in service calls with policyholders and agencies as necessary.
  • Draft correspondence related to coverage, including reservations of rights and disclaimers, as well as detailed communications to insured parties, claimants, and legal representatives.
  • Attend legal proceedings, depositions, and mediations as required, suggesting process improvements to enhance service quality.
  • Follow directives on complex or high-exposure claims and recommend appropriate reserves as needed.
  • Manage an assigned claim portfolio.
  • Perform additional duties or special projects as assigned.

Supervision

The role involves minimal direct supervision from the Claims Supervisor, with occasional oversight of independent adjusters and claim support staff.

Qualifications

  • Bachelor's degree in business, insurance, or a related field, or equivalent experience.
  • A minimum of five years of relevant claims handling experience with a track record of achievement and increasing responsibilities.
  • Possession of appropriate state Adjuster's License(s) as required.
  • For field-based roles, prior external experience is preferred, along with a valid driver's license.
  • Advanced knowledge of casualty claims and a commitment to professional development through recognized industry designations.
  • Extensive understanding of contract and tort law as it relates to insurance.
  • Strong analytical, negotiation, and communication skills.
  • Ability to exercise sound judgment in professional matters and collaborate effectively with various stakeholders.
  • Proficiency in Microsoft Office applications and familiarity with claims handling systems.
  • Capability to perform under pressure and manage stressful situations.

Working Conditions

  • This position may be based in a standard office environment or remotely, as determined by management.
  • Primarily sedentary role with frequent computer use.
  • Occasional overnight travel may be required.
  • Exposure to challenging situations related to claim disputes may occur.