The incumbent will Investigate, evaluate, reserve, negotiate and resolve assigned claims in accordance with Best Practices.
Provide quality claim handling and superior customer service on assigned claims while engaging in indemnity & expense management.
They will promptly manage GL claims by completing essential functions including contact, investigation, damages development, evaluation, reserving, litigation management, and disposition.
The incumbent also provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners.
Primary Job Duties & Responsibilities
Directly handle assigned severe GL claims.
Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Consult with Manager on use of Claim Coverage Counsel as needed.
Directly investigate each GL claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.
Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
Complete outside investigation as needed per case specifics.
Actively engage in the identification, selection and direction of appropriate internal and / or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
Verify the nature and extent of injury or damage by obtaining and reviewing appropriate records and damages documentation.
Maintain GL claim files and document claim file activities in accordance with established procedures Utilize evaluation documentation tools in accordance with department guidelines.
Proactively review CFAs for adherence to quality standards and trend analysis.
Utilize diary management system to ensure that all claims are handled timely.
At required time intervals, evaluate liability & damages exposure.
Establish and maintain proper indemnity & expense reserves.
Recommend appropriate cases for discussion at roundtable.
Attend and / or present at roundtables / authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
Apply the Company’s claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance.
Develop and employ creative resolution strategies.
Responsible for prompt and proper disposition of all claims within delegated authority.
Negotiate disposition of GL claims with insureds and claimants or their legal representatives.
Recognize and implement alternate means of resolution.
Manages litigated claims.
Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
Apply litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
Track and control legal expenses to assure cost-effective resolution.
Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Recognize cases, based on severity / complexity protocols, that should be transferred to another level of claim professional and refer on a timely basis.
Appropriately deal with information that is considered personal and confidential.
Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquires from agents and brokers.
Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable laws.
Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
Share accountability with business partners to achieve and sustain quality results.
Evaluate all claims for recovery potential; directly handle recovery efforts and / or engage and direct Company resources for recovery efforts.
Other duties as assigned.
High School Degree or GED required with a minimum of 3 years claim handling experience. Experience utilizing computer technology;
such as Microsoft Office, e-mail, Web-enabled applications, and database software. Ability to accurately compute a variety of numerical calculations required.
Licensing Required : In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.
Valid driver’s license may be required. Must secure and maintain company credit card if required.
Education, Work Experience & Knowledge
University / College degree or equivalent in business experience preferred.
Advanced level knowledge and skill in claim and litigation.
Basic working level knowledge and skill in various business line products.
Strong negotiation and customer service skills.
Extensive claim and / or legal experience and thus the technical expertise to evaluate severe and complex claims.
Able to make independent decisions on most assigned cases without involvement of supervisor.
Openness to the ideas and expertise of others actively solicits input and shares ideas.
Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
Demonstrated coaching, influence and persuasion skills.
Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
Can adapt to and support cultural change.
Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
Licensing or Certificates
In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.
Generally, License(s) are required to be obtained within three months of starting the job.