Senior Claims Resolution Specialist
2 days ago
At SET SEG, we're seeking a highly skilled and experienced Senior Casualty Claims Representative to join our team. As a key member of our claims department, you will be responsible for investigating, negotiating, and resolving designated PC claims in a timely and professional manner.
Key Responsibilities:- Manage and investigate assigned claims, ensuring adherence to guidelines and authority.
- Monitor outside investigators and perform outside investigations as assigned.
- Provide oversight of medical, legal damage estimates, and miscellaneous invoices to determine their reasonableness and relevance to designated claims.
- Negotiate disputed bills and invoices for resolution.
- Assign litigated claims to approved law firms and/or individual attorneys and monitor progress.
- Follow a uniform system of reserving by reviewing incoming litigation, establishing initial reserves, and completing reserve reports.
- Negotiate settlements in accordance with claim handling standards, considering member preferences when appropriate.
- Attend facilitations/mediations as assigned.
- Manage diary system to move losses to conclusion in a timely manner.
- Participate in strategy sessions with internal business units such as Underwriting and Loss Control.
- Bachelor's Degree plus five years of experience adjusting general liability and professional liability claims or an equivalent combination of education and experience.
- Knowledge of coverage, liability, and complex claims handling procedures.
- Ability to handle complex case-related tasks in a fast-paced and changing environment.
- Excellent interpersonal skills and the ability to work in a strong team environment.
- Highly organized and detail-oriented with a strong ability to maintain confidentiality.
- Strong cognitive and analytical skills with the ability to initiate, receive, understand, and reply to written and oral communication.
- Ability to travel and work remotely on a periodic basis.
SET SEG is a non-profit company that provides workers' compensation and property/casualty services for Michigan public schools. We value those who proactively solve challenges, simplify the complex, thrive in a fast-paced setting, have a customer-first mentality, and seek a collaborative and inclusive work environment.
We offer a competitive benefits package, including 100% employer-paid insurance, Paid Time Off (PTO), and paid parental leave. Our passion is delivering peace of mind to Michigan public schools, and we look for team members who are motivated by our cause.
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