Complex Claims Specialist – Professional & General Liability
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Complex Claims Specialist resolving professional and general liability claims for Pharmacists Mutual Insurance Group. Investigating, negotiating, and overseeing high-exposure litigated and non-litigated cases.
Responsibilities:
- Investigate, evaluate, reserve, negotiate and resolve assigned professional and general liability claims
- Handle complex litigated and non-litigated liability cases with the highest level of exposure
- Provide timely, professional claim handling and superior customer service
- Conduct coverage analysis and communicate with insureds based on policy information and case facts or allegations
- Investigate claims through contact with internal and external resources and experts
- Interview witnesses and take statements as necessary
- Use diary management systems to ensure timely claim handling and document protocol departures
- Attend and present at roundtables and authority discussions
- Resolve and close claims within delegated authority using creative or alternative resolution strategies
- Negotiate claim disposition with insureds, claimants and legal representatives
- Track and control legal and adjusting expenses
- Attend mediations, arbitrations, pre-trials, trials and other legal proceedings as needed
- Manage files through selection and direction of counsel under litigation guidelines
- Evaluate recovery potential and assist with recovery efforts
- Serve as a subject matter expert and provide coaching, file oversight and training resources
- Assist the manager with quality-control audits
Requirements:
- High School Diploma or equivalent and 10 years of related experience; or Associate’s Degree or equivalent and 8 years of related experience; and one of the listed industry-related certifications
- Bachelor’s Degree and 5 years of related experience; or Master’s Degree with 2 years of related experience
- One of the following industry-related certifications: AIC, AIC-M, AIM, CRM, SCLA, ARM or CPCU for the high-school/associate pathway
- Licensing required in some states
- Understanding of insurance claims principles and practices
- Understanding of complex policy and contract coverage
- Ability to manage, negotiate and resolve claims
- Ability to work longer hours when workload fluctuations occur
- Effective oral and written communication
- Ability to analyze complex issues and make critical decisions
- Excellent writing skills and professional English usage
- Ability to interpret and apply laws, rules and regulations
- Ability to manage and resolve multiple high-exposure claims simultaneously
- Proficiency with claims management software and Microsoft Office
- Ability to organize, prioritize work, work independently, meet deadlines and handle pressure
- Experience in professional liability, general liability and various other lines
- Advanced or specialized training/certifications preferred: AIC, AIC-M, AIM, CRM, SCLA, ARM, CPCU
Benefits:
- Annual discretionary bonus
- Health, Dental, Vision & Life coverage
- 401(k) with Company Match
- Paid Time Off
- 8 Paid Holidays
- Volunteer Time Off
- Paid Parental Leave
- Hybrid/Remote Work Options
- Employee Assistance Program
- Tuition Reimbursement
Similar Jobs
Claims Representative
Remote claims representative virtually inspecting property damage and advocating for owners with insurers. Metro Public Adjustment provides training and public insurance adjusting services.
Auto Injury Claims Adjuster
Auto injury claims adjuster handling attorney-represented bodily injury files for Roamly, a specialty insurer. Negotiating settlements and managing claims with AI-assisted workflows.
Integrated Absence Claims Specialist
Integrated absence claims specialist managing Short-Term Disability claims and associated leaves for Lincoln Financial, which provides insurance and retirement services. Reviewing medical records, communicating with claimants, and making claim determinations.
General Liability Claims Examiner
General Liability Claims Examiner managing high-exposure and litigated claims for a global third-party claims administrator. Evaluating coverage, negotiating settlements, and coordinating defense counsel through resolution.
Auto Claims Analyst
Analista de sinistros auto na Sossego, startup que simplifica operações de corretores de seguros. Acompanhamento de processos, atendimento e comunicação com segurados e corretores.
Claims Adjuster
Claims Adjuster investigating and resolving travel medical claims for Robin Assist, a global travel insurance assistance and claims partner. Ensuring compliant adjudication, accurate documentation, and compassionate customer support.
Liability Claims Associate
Remote liability claims associate adjudicating lower-level general liability claims for Sedgwick. Processing benefits, documentation, payments, and claimant communications.
Claims Adjuster
Claims Adjuster resolving complex travel medical claims for a global travel insurance company. Adjudicating benefits, processing invoices, detecting fraud, and supporting travelers worldwide.
Claims Representative
Claims representative helping New Jersey homeowners maximize insurance claim settlements. Inspecting property damage, interpreting policies, and guiding clients through claim paperwork.
Claims Examiner
Claims Examiner coding and adjudicating healthcare claims for Capital Blue Cross. Reviewing billing errors, researching coverage, and processing adjustments remotely from Pennsylvania.
Senior Casualty Claims Representative – Specialty Human Services
Remote casualty claims professional evaluating coverage, liability, damages, settlements, and reserves. Supporting Great American Insurance Group’s specialty human services insurance clients.
Claims Analyst – Casualty
Claims Analyst managing property damage, auto liability, and general liability claims for Blattner’s renewable-energy construction projects. Supporting investigations, settlements, recovery, and subrogation.
Claims Analyst
Claims Analyst processing and adjudicating Wisconsin medical insurance claims for TEKsystems. Reviewing benefits, billing, COB, repricing, and specialty claims remotely.
Associate Claims Examiner
Associate Claims Examiner processing low-complexity property and renters claims for MSI, a specialized insurance solutions provider. Supporting coverage reviews, settlements, documentation, and customer service.
Auto Claims Representative
Auto claims representative preparing repair appraisals and settling total-loss vehicles for Virginia Farm Bureau. Negotiating claims and authorizing supplemental repairs and payments remotely in Hampton Roads, Virginia.
Claims Representative
Claims Representative reviewing and adjudicating post-service medical necessity claims for Evernorth Health Services. Verifying coverage, managing authorization documentation, and resolving claim discrepancies remotely.
Pharmacy Claims Processor
Remote Pharmacy Claims Processor at PharMerica, managing rejected pharmacy claims and payer reimbursement. Supporting long-term care, senior living, and hospital pharmacy services.
Claims Processor I
Claims Processor I accurately adjudicating healthcare claims and resolving edits for Magellan Health. Maintaining reference materials and supporting claims operations.
Bodily Injury Litigation Claims Adjuster
Florida litigation claims adjuster investigating automobile bodily injury claims for Allstate. Evaluating coverage, liability, damages, and negotiating settlements remotely.
Liability Claims Examiner – General Liability Exp. Required
Remote Liability Claims Examiner handling high-exposure General Liability claims for Sedgwick, a global claims-management services company. Developing defense strategies and driving litigated cases toward resolution.