Senior Claims Resolution Specialist

1 month ago

Lake Mary, Florida, United States CNA Full time

Job Description

Key Responsibilities:

  • Manage a portfolio of complex claims, ensuring timely and adequate reserves by interpreting policy language and collaborating with coverage counsel.
  • Provide exceptional customer service, interacting professionally with insureds, claimants, and business partners to achieve quality and cycle time standards.
  • Conduct thorough investigations to determine compensability, liability, and covered damages by gathering information, taking statements, and working with experts.
  • AUTHORIZE AND ENSURE CLAIM DISBURSEMENTS WITHIN AUTHORITY LIMIT BY DETERMINING LIABILITY AND COMPENSABILITY OF THE CLAIM, NEGOTIATING SETTLEMENTS, AND ESCALATING TO MANAGER AS APPROPRIATE.
  • Identify and address subrogation/salvage opportunities or potential fraud occurrences by evaluating claim facts and making referrals to appropriate Recovery or SIU resources.
  • Maintain compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations, or trends for the line of business.

Requirements:

  • Bachelor's Degree or equivalent experience.
  • Typically a minimum four years of relevant experience, preferably in claim handling.
  • Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
  • Professional designations are a plus (e.g., CPCU).

Working Relationships:

  • Establish and maintain working relationships with internal and external work partners, suppliers, and experts by identifying and collaborating with resources needed to effectively resolve claims.

Skills and Knowledge:

  • Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
  • Solid verbal and written communication skills with the ability to develop positive working relationships, summarize, and present information to customers, claimants, and senior management as needed.
  • Ability to exercise independent judgment, solve moderately complex problems, and make sound business decisions.

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