ProSight Specialty Insurance

  • Claims Specialist

    Job Locations US-NJ-Morristown
    Posted Date 5 months ago(7/12/2018 1:06 PM)
    Job ID
    2018-1882
    # of Openings
    1
    Category
    Claims
  • Overview

    As a Claims Specialist, you’re an integral member of a distinguished department servicing our high profile clients and handling the teams’ most severe and complex liability claims. You’re highly intuitive and can interpret the immediate needs of a client to ensure that their day-to-day activities continue without interruption.

    Responsibilities

    • Ability to interpret and apply customized Insurance policies to real life situations.
    • Conduct thorough, high-quality investigations and utilize outside resources as necessary.
    • Assigned claims may involve coverage interpretation and litigation, including specialized coverage extensions.
    • Prepares appropriate coverage letters for review and approval by claims management.
    • Completes an investigation on each claim in a timely manner and fully documents the claim file with claim details.
    • Handles assigned claims following company guidelines and industry best practices.
    • Promptly identifies claims that have significant exposure or suspected fraudulent activity.
    • Oversight responsibilities for a TPA to add value and claims expertise.
    • Sets accurate reserves on each claim within given authority level and promptly advises management of claims that will require reserves exceeding authority.
    • Completes timely and high quality large claim reports with limited management input and editing.
    • Maintains a diary system that assures that each assigned claim will receive necessary ongoing attention.
    • Travels to attend mediations, settlement conferences and trials as needed.
    • Uses the claims system to accurately change reserves and make payments within assigned authority levels.
    • Closely manages defense counsel, outside investigators and surveyors to ensure that loss adjustment expenses are appropriate.
    • Meets with members of other departments to discuss specific claim details or general claims issues.
    • May be designated as claims contact for key accounts and programs in which case the Specialist will perform various account or program management tasks including:
    • Preparing for and attending claim reviews
    • Analyzing claims data and meeting with members of other departments to discuss the account status
    • Meeting with and making presentations to account or program representatives
    • Maintains adjuster licenses in states as required.
    • May be called upon to perform other tasks and duties within the claims department as dictated by business needs.

    Qualifications

     

    • 8+ years of claim handling experience
    • 2+ years handling severe claims involving complex coverage issues and litigation
    • Ability to evaluate policy language and apply to claim
    • Willingness to accept challenges and take on new responsibilities
    • Bachelor’s degree preferred
    • Prior P&C insurance experience is a plus
    • Solid planning & organizational skills including time-management and prioritization
    • Analytical skills to identify, gather, and organize information
    • Customer focused attitude and skills to resolve inquiries quickly and effectively
    • Strong verbal & written communication skills

     

     

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