Sr Commercial Claims Specialist

Overview of Position

The Senior Commercial Claims Specialist will assist policyholders throughout the entire claims process.  Ability to work extended hours, including evenings and weekends, based on customer and business needs, (e.g. in response to claim volume fluctuation due to catastrophic weather) may be required.

The Senior Commercial Claim Adjuster will handle a caseload which encompasses all levels of complexity for first-party claims, including establishing facts of loss, conducting proper reserve and coverage analysis, assessing and estimating property damage, assigning experts as needed, identifying potential fraud and timely investigate claim for proper resolution. The Senior Commercial Claim Adjuster will also serve as a mentor to junior adjusters and assist with training, as needed.

Successful candidate must be able to attend trainings and assist management with other duties and responsibilities, as requested.

Knowledge of insurance regulations claims practices and statutory requirements, governing case law, ADR methodology, DFS mediation and disputed claims resolution is required.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Verify facts of loss and pertinent information to analyze and confirm coverage.
• Establish ultimate reserves (anticipated cost to bring file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Explain and appropriately respond to insured’s, public adjusters, attorney’s and contractors during telephone contacts; as well as, contact the appropriate parties to obtain any needed information, provide timely investigation status updates, explain settlements and/or ultimate claim disposition.
• Timely submit reserve and payment approval requests, as appropriate.
• Identify claims requiring a Reservation of Rights and refer for management approval.
• Formulate and execute appropriate ADR strategy in compliance with statutory guidelines.
• Check e-mails and messages daily. Respond to all calls, emails, and questions daily.
• Apply advanced negotiation skills to effectuate resolution of disputed claims with insureds or their legal representative.
• Coordinate appraisal process, maintain communication necessary to ensure appraisal process is moving forward in timely fashion.
• Draft denial letters for management approval.
• Identify and refer claims with subrogation potential to the subrogation department.
• Identify and refer cases with potential NICB fraud indicators.
• Virtually investigate and resolve claims, as appropriate, with the use of video technology.
• Close all files as appropriate in a timely and complete manner.
• Serve as mentor and/or trainer, as needed, to junior adjusters.
• Strictly adhere to Best Practices and operational guidelines, as well as all statutory requirements.
• Interfaces with company clients, carrier, adjusters, or covered parties. Communicates with agents regarding status of claim.
• Completes and/or reviews, approves, or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
• Resolves disputes regarding claims resolution. Responsible for reopening and re-evaluating claim, as necessary.
• Participates in litigation when applicable.

EDUCATION and/or EXPERIENCE 

• Bachelor's degree
• A minimum of 10 years of Commercial claims experience preferred.
• In-depth professional knowledge of all aspects of claims operations.
• Florida 520/620 license is required.
• Ability to obtain AL, GA, NC and SC adjusters licenses.
• Strong commercial coverae interpretation and claims handling background is required.
• Must have commercial construction knowledge and be proficient in Xactimate.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Must also be able to deal with problems involving several concrete variables in standardized situations.

SKILLS

• Language Skills: Ability to read and interpret policies, correspondence and governmental regulations. Ability to write reports as well as business and technical correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Computer Skills: Must be proficient with programs such as Word, Excel, Outlook, Adobe and other programs used by the company such as Guidewire, Legacy, Xactimate and Xactanalysis.
• Mathematical Skills. Ability to calculate figures and amounts such as interest, proportions, percentages, area, circumference, and volume. Ability to apply basic algebra and geometry.
• Reasoning Ability. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

• Comfortable working independently with a high degree of proficiency and self-motivation.

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