Complex Claims Manager (Hybrid)

Description:

Job Details:
The Complex Claims Manager is responsible for reviewing and analyzing Complex Claims files, focusing on extra contractual claim assessments and risk avoidance. This role involves evaluating potential exposures, identifying cases for settlement, and developing strategic plans with defense and coverage counsel to resolve litigated claims efficiently and cost-effectively.
What does a Complex Claims Manager do at An Insurance Company?

• Review files to determine potential exposures and identify extra-contractual obligations.
• Analyze the cost-effectiveness of litigation versus settlement.
• Collaborate with defense counsel on claim handling strategies, roles, responsibilities, and budgets.
• Ensure legal compliance by accurately documenting findings and recommendations.
• Handle litigated and extra contractual files according to guidelines and timelines.
• Attend mediations and trials and participate in Complex Claims roundtables providing technical direction.
• Correspond with defense, plaintiff, and coverage counsel.
• Direct and monitor cases assigned to defense counsel and reconcile invoices for billed Defense Services.
• Partner with Senior Claim Leadership, Underwriting, and Actuary on claims, litigation developments, coverage trends, reserve movements, and loss mitigation efforts.
• Identify emerging legal and claims trends and provide technical guidance to claims and business partners.
• Manage and maintain the claims Watchlist and implement resolution strategies.
• Make timely contacts and inform all relevant parties of case status.
• Communicate proactively with key business partners in other departments.
• Participate in or lead special projects and assist in creating technical guidelines and governance.

Education:

• Bachelor's degree and JD (Juris Doctorate)

• Active State Bar License, Texas License preferred.
• Active Adjusters License preferred.

Experience:

• Minimum 10 years bodily injury claims adjusting experience in the auto insurance industry.
• Experience in Arbitration and Mediation negotiations required.
• Knowledge of automobile damage, mechanics of bodily injury, medical terminology, settlement negotiations and insurance case law.
• Experience in handling high exposure claims involving extra contractual exposure.
• Prior experience interpreting policy language and state statutes is required.
• Prior experience in reviewing and analyzing Complex Claims files to determine potential exposures, identify cases that should be recommended for settlement, and developing strategic plans with defense counsel to resolve litigated claims in an efficient, cost-effective, quality manner.
• Proven track record of making sound coverage and liability decisions based on facts presented by customers and/or through additional fact gathering and investigations.
• Experience in handling high exposure claims involving extra contractual exposure.

Skills and Abilities:

• Successful track record managing diverse teams across multiple projects.
• Ability to manage multiple projects in a fast-paced, dynamic environment.
• Strong understanding of project management methodologies, tools, and techniques.
• Analytical mindset with the ability to make data-driven decisions.
• Excellent communication, collaboration, and relationship-building skills.
• A willingness to work occasional weekends or extended hours as required.
• Travel to mediations, trials and conferences as required.

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