Senior Complex Claims Specialist

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.
**This position is eligible to work from home anywhere in the US**
Directly handles the company's most complex casualty claims and litigated claims on a nationwide basis. Models best claims handling practices with an emphasis on the strategic handling and resolution of these complex claims. Delivers timely, expert support to the regional casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves.
Essential Functions:
Directly handles the company's most complex claims and litigated claims involving serious injuries and highly sensitive/high profile cases

Proactively handles assigned claims to conclusion while modeling best claims handling practices, managing expenses, and pursuing early resolution when appropriate to positively impact indemnity outcomes

Serves as the subject matter expert on highly complex coverage issues impacting assigned claims, seeks assistance when needed or appropriate, issues coverage correspondence, and takes coverage into account when setting reserves and driving claims towards resolution

Sets timely, accurate, and well-documented reserves with proper communication to the agent, Branch VPs, and claims leadership while taking exposure, liability, allocation, and coverage into account

Conducts timely, thorough investigations into coverage, liability and damages while identifying, utilizing, and managing appropriate vendors based on need, expertise, expense, and geographic considerations

Prepares timely, concise, claim evaluations and file reviews

Develops, documents, and executes negotiation plans

Maintains timely and appropriate diary on all claims for optimum case control, exposure evaluation, expense management, and progress towards resolution

Composes concise claim notes, attaching documents when appropriate and using proper claim note categories and document titles

Collaborates with defense counsel to develop strategic defense and resolution strategies with action plans, appropriate budgets and invoice reviews.

Presents claims in Claim Committee and Complex Roundtables and facilitates claim file discussions, and engages in Committee discussion to share technical claim handling and resolution expertise

Attends all mediations and trials, as necessary

Provides expert guidance to General Casualty, Complex, and/or Specialty Teams, including on serious injury claims
Reviews and communicates comprehensive evaluations of assigned claims presenting serious injuries (such as fatality, amputation, loss of sight, burns, paraplegia, quadriplegia, sex abuse, etc.), intellectual property claims, and claims with exposures of $750,000 or greater

Provides timely communication and assistance to various claims adjusters, managers, directors and/or claims leadership on issues requiring special attention

Provides follow up reviews when appropriate

Contributes to ongoing regional needs assessment analysis with insights gathered during Casualty collaboration process

Promotes and supports improved technical claims handling across claims teams in accordance with Best Practices

Identifies, recommends, develops, and delivers new training programs based on identified needs, opportunities, and industry trends, in collaboration with Learning and Development and claims leadership

Prepares engaging presentation materials and provides significant contributions as a leader and/or facilitating member during trainings

Identifies regional claims team members as potential candidates for the Complex Casualty Claims team

Actively participates in special projects to build company claims handling expertise and promote improved claim outcomes

Delivers exceptional customer service to General Casualty, Complex and/or Specialty Teams, insureds, agents, and internal customers

Delivers timely, expert support to the Casualty claims teams on technical claims handling, negotiation strategy, coverage, liability, damages, and reserves

Provides insureds and agents with concise, accurate status of claim activity and explanations of coverage, claim value and settlements

Promptly and appropriately responds to regional claim teams, insureds, agents, and internal customers

Serves as a technical subject matter consultant for regional team members and makes recommendations to Claims Consultant, Manager and/or Director for technical claims handling growth

Education & Experience:

Bachelor’s degree, preferably in business, economics, or related field, or equivalent related experience

Ten years of experience in complex claims handling or claims litigation, or relevant experience, including at least three years of claims litigation experience

Insurance designations such as AIC, CPCU, and/or other insurance education preferred

Knowledge, Skills & Abilities:

Exceptional knowledge of litigation management, coverage, and technical file handling

Strong knowledge of the theory and practice of the claims function

Strong ability to evaluate legal liability, damages, coverages, and exposure

Excellent knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal liability for all commercial lines of insurance

Excellent leadership, collaboration, and negotiation skills

Excellent knowledge of computers and claims systems

Strong organizational, written and verbal communication skills

Excellent customer service skills

Advanced investigative and problem-solving abilities

Travel required (20%); a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

The hiring salary range for this position will vary based on geographic location, falling within either of the following:
$103,954 - $149,372 or $114,895 - $164,309A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.
For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.
Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.
All of our locations are tobacco free including in company vehicles.
Originally posted on Himalayas