Senior Complex Claims Specialist

Oliver James is working with a Specialty subsidiary of an insurance carrier who is seeking to hire a Senior Complex Claims Specialist.

The ideal individual for this role will have extensive experience handling litigated claims for the public sector.

Holding a NY or CA adjusters license is required.

Job Overview

The Senior Complex Claims Specialist role is part of our client's Specialty division. This is a senior-level examiner role charged with the full lifecycle of handling complex claims. You are expected to come in with extensive coverage analysis experience and a strong understanding of liability exposure.

What You'll Do

• Manages a portfolio of high-severity Property and Casualty claims, with emphasis on Professional Liability exposures; supports other lines of business as required.
• Oversees complex, high-impact claims from inception to closure, applying deep knowledge of coverage interpretation and legal exposure analysis.
• Reviews detailed policy language and endorsements to assess applicable coverage and exclusions for each claim scenario.
• Collaborates closely with internal departments and external service providers to streamline the claims process and ensure regulatory adherence.
• Gathers and evaluates claim-related information from multiple parties, including insureds, legal counsel, and third-party sources; identifies potential for recovery and addresses inconsistencies in reported losses.
• Flags potential coverage issues early in the claim lifecycle and evaluates historical loss data; initiates referrals to the Special Investigation Unit (SIU) when warranted.
• Negotiates settlements within assigned authority, and works with leadership to develop resolution strategies for claims exceeding that threshold.
• Maintains comprehensive, timely, and well-organized documentation in all claim files to support audit readiness and internal reporting.
• Leads litigation strategy on contested files, aligning defense efforts with overall business objectives and industry best practices.
• Leverages advanced claims expertise to drive favorable outcomes through detailed analysis, proactive negotiation, and alternative resolution methods.
• Monitors and communicates emerging risk patterns or loss trends to help inform underwriting and risk mitigation strategies.
• Escalates potential fraud indicators and collaborates with investigative teams to support case development.
• Contributes to cross-functional initiatives, special assignments, and departmental improvements as needed.
  
  

Qualifications

WHAT YOU'LL BRING:

• 7 years of relevant experience
• Bachelor's degree
• Any relevant certifications
  
  

Please apply to be considered. Only shortlisted candidates will be contacted.

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