Claims Serv Specialist III

Under limited supervision, investigate and resolve first and third party material damage, WC, PIP, BI, GL and Property claims which may involve coverage, liability, damage and legal issues. Effort may concentrate around intermediate exposure, Commercial Auto, Homeowner liability, and/or Commercial Property claims among other market/line combinations with stretch assignments based on experience. Provide guidance and direction to legal counsel during the litigation process in order to ensure favorable resolution. Act as a mentor to new employees to facilitate the on-boarding process.

Key Responsibilities

• Timely completion of all case activities, maximizing customer service and minimizing net loss payout. 

• Contacts all insureds, claimants and witnesses that may have information relating to the loss, either in person, by 

• telephone or in writing. This may include visiting the accident location to examine, photograph and diagram 

• physical facts and conduct neighborhood canvasses. 

• Inputs and retrieves information using the automated claims system, requests checks, form letters and other 

• correspondence through the automated claim system. 

• Evaluates case facts determining coverage, liability and reserves, and reports on settlement; maintains a reminder system. 

• Interprets and evaluates medical reports to determine if they are applicable to the claim; monitors legal and medical billings and investigates for proper charges and pays accordingly. 

• Negotiates settlements with individuals, attorneys, and other insurance carriers within their granted settlement 

• authority level. 

• Pursues subrogation and may arrange for salvage to obtain the maximum recovery. 

• Prepares detailed scope of damages on property losses and brings to conclusion. 

• Assists, when requested, in the selection and evaluation of experts as needed. 

• Manages litigation, checking to ensure that coverages are not exceeded, that legal expenses are adequate, and confers with attorney about case direction and disposition. 

• Will participate in special projects or training programs. 

• Will assist in the training of Claims Service Specialists II and below. 

• Performs other related duties as required or requested. 

• Will keep management informed of activities and problems within assigned area of responsibility. 

• Provides information to all interested parties, including the local agents, by answering routine questions regarding the status of the claim. 

• Successfully completes all required training and applies. 

• Meets basic claim handling performance standards. 

• Manage and track all claims referred to Subrogation counsel. 

• Daily navigation and management of E-Subro Hub. 

• Prepare well written contentions for arbitration filings, including Special arbitrations, when coverage, liability and/or damages are in dispute. 

• Manage stretch assignments based on experience with oversight.

Requirements

• Success will be measured based on individual results compared to all established department standards in Customer Service, Teamwork, Loss and Expense Management, as well as Continuous Improvement.

• Excellent communication, customer service and collaboration skills

• 3-5 years of equivalent work related experience

• 2 or more years as a Claim Service Specialist II

• Demonstrated success in handling MD, PIP, BI in MA, CT, Commercial

• Where applicable pass the state licensing requirements

• Valid drivers license in good standing