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Claims Specialist


Job Summary

To handle single and multi-party personal or commercial line claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

Job Accountabilities - Key Accountabilities


  • Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.
  • Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
  • Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
  • Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
  • Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
  • Assess damages by calculating applicable damages or range of damages allowed by law.
  • Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
  • Meet quality standards by following best practices


Job Qualifications


  • Bachelor’s Degree and 5 or more years of experience in the Claims and/ or Litigation Management area.


  • Must obtain and maintain required adjuster license(s)
  • Microsoft Office experience


  • Effective verbal and written communication skills
  • Strong analytical, critical thinking and problem-solving skills
  • Strong multi-tasking and prioritization skills
  • Experience collaborating in a team environment and building cross functional working relationships
  • Proactively shares and promotes sharing of insights
  • Ability to gather unique perspectives from other teams/functions to optimize outcomes.
  • Understands, analyzes, and applies the component parts of an insurance policy for complex claims
  • Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
  • Ability to determine the scope and exposure for complex claims
  • Ability to leverage trend and relationships to provide high-quality customer service
  • Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
  • Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
  • Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
  • Knowledge of insurance regulations, markets and products


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