Claims Specialist II/III

Department: Member Services - Claims
Reports to: Claims Supervisor
Job Level / FLSA: Professional/Managerial #3 / Exempt

Summary

This is a mid or senior level claims position for an experienced adjuster with at least five years’ experience investigating, evaluating and resolving 3rd party personal lines liability claims with a focus on bodily injury claims analysis and settlement inclusive of UM/UIM exposures. This is a full-time position with the possibility of remote or hybrid based on experience. The candidate must reside within the state of Virginia.

Essential Duties and Responsibilities

The Claims Specialist II or III is responsible for the resolution of moderate to high complexity and exposure claims which are subject to disputes that must be resolved in mediation or litigation. The primary purpose of this job is to handle claims from the coverage, liability and settlement analysis. Timely resolution, ensuring mitigation of indemnity and expense exposures while communicating developments and outcomes as necessary to all internal and external stakeholders.

The position will have increased responsibility for decision making within their authority and work with minimal oversight. This role will provide training and be a technical referral point for other team members.

• Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Analyzes coverage and communicates coverage decisions
• Directs and monitors assignments to experts and defense counsel.
• High level verbal and written communication skills: explaining and/or in writing coverage denials, reservation of rights letter, coverage limitations, etc.
• Conducts, coordinates, and directs investigation into loss facts and extent of damages.
• Timely initial and follow up contact with all parties. Responding to incoming inquiries according to company policy and procedures.
• Evaluates information on coverage, liability, and damages to determine the extent of our members exposure.
• Sets reserves within authority or makes claim recommendations concerning reserve changes to manager.
• Negotiates and settles claims typically in litigation either directly or indirectly.
• Prepares reports by collecting and summarizing information on property and/or bodily injury claims.
• Present at claims conferences involving senior claims leaders and team members on litigated and non-litigated files.
• Participates in special projects or assists other team members as requested.
• Travel to mediations, trials, and conferences as required.

Other duties as assigned. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

All employees are expected to participate in catastrophic events.

Skills Required

Must be able to read, analyze and understand technical reports, related documents. Must be able to verbally communicate decisions and negotiate effectively with all Customers, internal and external. Will be required to possess the skills to author reports and letters that are persuasive and professional. As most of the contact with Customers is done verbally and via telephone, individual must be able to speak clearly, politely, use proper grammar and terms that are familiar to the general public. Basic typing skills are essential. Some knowledge of Microsoft Word and related products is helpful. Must be able to gather information, establish facts, and evaluate data to determine coverage, liability and damages. Must be able to apply applicable law, contractual terms and conditions and statutory requirements to the decision-making process. Basic math skills that will allow preparation and evaluation of damage estimates as well as percentages for depreciation and liability. This job requires that the employee’s skills are continuously updated to keep abreast of changing policy forms, laws and statutory regulations.

Qualifications

Bachelor’s Degree and/or 5 to 10 years’ experience handling bodily injury claims in the property and casualty industry. Litigation claims handling is a plus.

Supervisory Responsibilities

None but will assist with training of staff.

Physical Demands and Work Environment

Most of this job is done in an office environment but may require onsite inspection or travel to meet with Agents, policyholders, claimants and vendors on occasion. Reasonable accommodations may be made to enable those with physical disability to perform essential functions. The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee will be required to sit, talk, see and hear. The employee is frequently required to use hands to type, key numbers and handle paper documents.

Reasonable accommodations may be made to enable those with physical disabilities to perform essential functions.

To Apply

Email your resume to nninsjobs@nnins.com and we'll reach out if your skill set fits our requirements.