Claims Resolution Specialist
2 weeks ago
We are seeking a highly skilled Senior Casualty Claims Representative to join our team at SET SEG. As a key member of our claims team, you will be responsible for the investigation, negotiation, adjustment, and resolution of designated PC claims.
Key Responsibilities:
- Manage, investigate, evaluate, negotiate, and adjust assigned claims in adherence to guidelines within authority.
- Ensure adequacy of reserves and recommend reserve increases on cases in excess of authority.
- Monitor outside investigators and perform outside investigations when assigned.
- Provide oversight of medical, legal damage estimates, and miscellaneous invoices to determine if they are reasonable and related to designated claims.
- Negotiate any disputed bills or 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 while also 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.
Requirements:
- Bachelor's Degree plus five years of experience adjusting general liability and professional liability claims or an equivalent combination of education and experience.
- Must have 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.
- Must be highly organized and detail oriented.
- Must be dependable, reliable, and able to achieve high levels of professionalism when handling cases and interacting with school district representatives and their employees, attorneys, families of injured, and fellow employees.
- Must be able to create and maintain high levels of confidentiality when dealing with proprietary information and sensitive situations.
- Must have strong cognitive and analytical skills.
- Ability to initiate, receive, understand, and reply to written and oral communication (verbal, written, telephone, e-mail, etc.).
- Ability to travel and work remotely on a periodic basis.
We Value:
SET SEG is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.
About SET SEG:
School Employers Trust (SET) is a non-profit company that was created after a monumental shift in school funding happened in 1965. SET, which began in 1971, served as an employee benefits association focused on offering comprehensive and affordable employee benefit solutions to Michigan public schools and their employees. Two years later, its partner organization School Employers Group (SEG) was formed to administer compensation and fringe benefits for SET. As schools were faced with more challenges related to insurance, SEG evolved and grew into a company that provides workers' compensation and property/casualty services for Michigan public schools.
Today, SET SEG continues to expand and find creative ways to meet the specialized needs of its members. This, coupled with a superior member experience, is why SET SEG has maintained its position as an industry leader in the school insurance market.
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