Complex Claims Consulting Director

7 months ago

Lake Mary, United States CNA Full time

JOB DESCRIPTION

:

Essential Duties & Responsibilities:

Performs a combination of duties in accordance with departmental guidelines:

Manages an inventory of the most complex and high exposure Lawyers Professional Liability Claims by following company protocols to manage and oversee all aspects of the claim handling, including coverage determinations, investigations, and resolution strategies which may include pursuit of risk transfer, extensive negotiations and complex litigation management. Ensures exceptional customer service by driving continuous improvements for all aspects of the claim/account, providing professional and timely claims services, and achieving quality and cycle time standards.  Verifies coverage, sets and manages timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel as needed, estimating potential claim valuation, and following company's claim handling protocols. Leads all activities involved with a focused investigation to determine compensability, liability and covered damages by gathering pertinent information, documenting statements from customers/ claimants, and working with experts, or other parties, as necessary to verify the facts of the claim. Drives the resolution of claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority. Establishes and manages significant claim budgets by identifying, selecting and actively managing appropriate resources, delivering high quality services, and coordinating all efforts leading to timely resolution of the claim/accounts. Discovers and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making appropriate referrals to appropriate Claim, Recovery or SIU resources for further investigation. Achieves quality standards by effectively managing each claim to ensure that all company protocols are followed, work is accurate and timely, all files are properly documented and claims are resolved and paid timely.  Prepares and presents high profile, complex information to senior leadership, customers, counsel, and others by effectively identifying high profile matters, developing executive loss summaries, coordinating and communicating resolution strategies and sharing relevant current events and case law. Maintains subject matter expertise and ensures compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for the specialized line of business, and may represent company in industry trade groups or other important events. Mentors, guides, develops and delivers training to less experienced Claim Professionals and may assist with special projects as needed.

May perform additional duties as assigned.

Reporting Relationship

Typically Director or above

Skills, Knowledge & Abilities

Expert knowledge of the professional services industry, ideally Lawyers Professional Liability claims, policy language, coverage, and claim practices. Excellent verbal and written communication skills with the ability to develop collaborative working relationships, articulate very complex claim facts, analysis and recommendations in a concise manner to senior management, as well as with external business partners and customers. Demonstrated analytical and investigative mindset with critical thinking skills and ability to make sound business decisions, and to effectively evaluate and resolve ambiguous, complex and challenging business problems. Extensive experience in leading complex negotiations, as well as developing and implementing resolution strategies.  Strong work ethic, with demonstrated time management, organizational skills, and an ability to work independently in a fast-paced environment. Ability to drive results by taking a proactive long-term view of business goals and objectives.  Extensive experience interpreting commercial insurance policies and coverage.  Ability to partner with internal resources, oversee/manage outside counsel, and collaborate with other carriers. Ability to lead multiple and shifting priorities in a fast-paced and challenging environment. Knowledge of Microsoft Office Suite and ability to learn business-related software. Demonstrated ability to value diverse opinions and ideas.

Education & Experience:

Bachelor's degree with JD preferred in a related discipline or equivalent. Typically a minimum ten years of relevant experience. Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. Advanced negotiation experience Professional designations are highly encouraged (e.g. CPCU)

  • Complex Claims Specialist – Architect and Engineer Liability

    7 months ago

    Lake Mary, United States CNA Full time

    JOB DESCRIPTION : Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize...

  • Senior Claims Leader

    4 weeks ago

    Lake Mary, Florida, United States Frontline Insurance Full time

    About the RoleAs a Senior Claims Leader at Frontline Insurance, you will oversee the management of large and complex claims, ensuring timely and effective resolution. This role involves working closely with the Director of Claims to ensure seamless claim handling processes.Key ResponsibilitiesClaims Oversight: Assist in supervising claim handlers to...

  • Claims Examiner

    4 months ago

    Lake Mary, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...

  • Claims Management Director

    5 days ago

    Lake Success, United States Northwell Health Full time

    Job Summary:The Northwell Health Claims Management Director is responsible for leading the organization's claims management program, including Professional Liability, Employment Practices Liability, and Directors' and Officers' Liability. This role oversees a team of 2-4 staff members, manages a comprehensive process for litigating non-workers' compensation...

  • Senior Insurance Claims Professional

    2 weeks ago

    Lake Mary, Florida, United States Tailored Management Full time

    We're seeking a talented Customer Service Senior Representative to join our team at Tailored Management. This exciting opportunity allows you to work with a global health insurance provider dedicated to improving the health and well-being of its customers.The estimated annual salary for this position is $70,000-$90,000, reflecting the company's commitment to...

  • Sr. Commercial Claims Examiner

    4 weeks ago

    Lake Mary, United States Frontline Insurance Managers, Inc. Full time

    Senior Commercial Claims Specialist SUMMARY Are you an experienced commercial claims professional looking to make an impact? Frontline Insurance is seeking a Senior Commercial Claims Specialist to assist policyholders throughout the entire claims process. This role requires the ability to work extended hours, including evenings and weekends, based on...

  • Senior Claims Resolution Specialist

    2 months ago

    Lake Mary, Florida, United States CNA Full time

    Job DescriptionKey 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...

  • Customer Experience Consultant

    4 weeks ago

    Lake Mary, Florida, United States Addition Financial Full time

    Job SummaryWe are seeking a highly motivated and experienced Customer Experience Consultant to join our team. As a key member of our operations center, you will play a vital role in providing world-class customer service to our members.About the RoleThe primary responsibility of this position is to handle member calls and provide individualized solutions to...

  • Contract Analyst

    2 weeks ago

    Lake Mary, United States Pyramid Consulting, Inc Full time

    Immediate need for a talented Contract Analyst. This is a 05+months contract opportunity with long-term potential and is located in Lake Mary, FL (Remote). Please review the job description below and contact me ASAP if you are interested.Job ID: 24-53189Pay Range: $27 - $28.78/hour. Employee benefits include, but are not limited to, health insurance...

  • Electrical Utility Design Consultant

    6 days ago

    Lake Mary, Florida, United States Pickett and Associates, Inc. Full time

    Job Title: Electrical Utility Design ConsultantAbout Our Services:Pickett and Associates, Inc. offers a range of engineering services to clients throughout the US and Caribbean, including transmission line engineering, surveying, and design consulting.The Position:We are seeking an experienced Electrical Utility Design Consultant to provide expert advice on...

  • Insurance Claims Examiner

    2 weeks ago

    Lake Elmo, Minnesota, United States Auto-Owners Insurance Full time

    Auto-Owners Insurance: Unlocking Opportunities in Property and Casualty ClaimsA career at Auto-Owners offers a unique blend of challenge and reward, with a focus on creating financial security for individuals and businesses. Our team of experts is dedicated to helping clients navigate the complexities of insurance claims. Job Overview: As a Field Claims...

  • Claims Manager

    3 weeks ago

    Woodcliff Lake, United States Hilb Group Full time

    OverviewGrow With Us! At Hilb Group, we recognize that our associates are our greatest asset. We promote a service-driven culture of high performance that encourages career and professional development. The Hilb Group is currently seeking a motivated and ambitious Claims Manager to join our team. This position will report to our agency located in Mahwah, NJ....

  • Complex Itinerary Consultant

    2 days ago

    Salt Lake, Utah, United States ADTRAV Travel Management Full time

    About Our CompanyADTRAV Travel Management is a leader in the travel management industry, providing innovative solutions for over 40 years. We are dedicated to excellence and strive to deliver exceptional results for our clients.Job DescriptionThe Travel Consultant will be responsible for managing all aspects of travel for our clients, including booking...

  • Highly Skilled Construction Inspection Manager

    6 days ago

    Lake Mary, Florida, United States SAI Consulting Engineers Full time

    Job OverviewWe are seeking a highly skilled and motivated individual to join our team as a Senior Project Engineer in our Florida (Orlando) Construction Office.About SAI Consulting Engineers, Inc.SAI Consulting Engineers, Inc. is a leading transportation design and construction management firm based in Pittsburgh with offices in Harrisburg, Philadelphia, and...

  • Claims Resolution and Management Intern

    6 days ago

    Lake Elmo, Minnesota, United States Auto-Owners Insurance Full time

    Claims Resolution and Management InternJoin Auto-Owners Insurance as a claims resolution and management intern and gain valuable experience in the insurance industry. This exciting opportunity allows students to develop skills in investigation, analysis and resolution of claims.Key Responsibilities:Investigate claims to determine policy coverage and evaluate...

  • Insurance Claims Handler

    2 weeks ago

    Lake Elmo, Minnesota, United States Auto-Owners Insurance Full time

    Job SummaryAuto-Owners Insurance is seeking a skilled Field Claims Professional to handle insurance claims in the field. This role requires strong claims-handling skills, excellent communication abilities, and the capacity to resolve complex issues.Key ResponsibilitiesInvestigate and evaluate insurance claims, ensuring accurate and timely resolutionProvide...

  • Compensation Claims Analyst

    11 hours ago

    Lake Charles, Louisiana, United States Center for Orthopaedics Full time

    Job Title: Compensation Claims AnalystSalary Range: $60,000 - $70,000 per yearWe are seeking a skilled Compensation Claims Analyst to join our team at the Center for Orthopaedics. This individual will be responsible for analyzing and resolving complex compensation claims, ensuring compliance with regulations and company policies.About the Role:Analyze and...

  • Sales Director

    2 weeks ago

    Lake Mary, Florida, United States Finastra USA Corporation Full time

    About the Job DescriptionFinastra USA Corporation seeks a Sales Director to manage multiple accounts and drive client retention and growth. The successful candidate will have 5+ years of progressive experience in consultative sales and account management, previous experience with CRM technology, and strong written, verbal, and presentation skills.You will...

  • Contract Pricing Analyst

    1 week ago

    Lake Mary, Florida, United States Pyramid Consulting, Inc Full time

    Job Opportunity OverviewWe are seeking a Contract Pricing Analyst to join our team at Pyramid Consulting, Inc., a leading Insurance Industry expert. This is a contract opportunity with long-term potential and can be performed remotely from Lake Mary, FL.The estimated salary for this position is $27-$28.78 per hour, along with a comprehensive benefits package...

  • Construction Engineering Manager

    4 weeks ago

    Lake Mary, Florida, United States SAI Consulting Engineers Full time

    OverviewSAI Consulting Engineers is a leading transportation design and construction management firm with offices in multiple locations. We are seeking an experienced Construction Engineering Manager to join our team in Florida.Job SummaryWe are looking for a seasoned professional to lead our Construction Inspection Department in Florida. As a key member of...