Major Case Specialist - Construction Defect Job
Date: Mar 29, 2014
Location: Alpharetta, GA, USA
That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.
Investigate, evaluate, reserve, negotiate and resolve assigned serious and complex claims in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, and disposition. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.
PRIMARY DUTIES AND RESPONSIBILITIES:
Directly handle assigned severe and/or complex 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 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 nurse consultants, and fire or fraud investigators, and other experts.
Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Maintain 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.
Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
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 deep knowledge of creative resolution techniquesto improve the claim results of others.
Apply the Companys claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.
Develop and employ creative resolution strategies.
Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of 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 our customers.
Apply expert 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.
Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.
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 state 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.
May be responsible to research and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.
May assist underwriting business partners in marketing and account-contact efforts.
May participate in periodic file quality reviews.
EDUCATION/COURSE OF STUDY:
College degree or equivalent business experience.
10+ years claim handling experience with 5 - 7 years experience handling serious injury and complex liability claims preferred.
Extensive working level knowledge and skill in various business line products
Excellent negotiation and customer service skills
Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management 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 strong 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 effect
State insurance adjusting license (where applicable) and ongoing satisfaction of any necessary continuing education requirements.
Leading the Business:
Executes Business Strategy
Attract Top Talent
Maximize Individual Performance
Holds Others Accountable
Creates and Sustains a Dynamic Workplace-promotes Enterprise culture
Leading Self-Emotional Intelligence
Demonstrates Self-Awareness-initiative and accountability
Applies Critical Thinking
Communicates Effectively & Influences Others
Exhibits Courage, Conviction & Credibility
Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
Job Category: Claim
Job ID: 811666
Nearest Major Market: Alpharetta
Nearest Secondary Market: Atlanta
Job Segments: Construction, Underwriter, Claims, Medical, Law, Engineering, Insurance, Healthcare, Legal