What are the responsibilities and job description for the Claims Specialist position at Superior Grocers?
Job Details
Description
Position Summary:
The Claims Specialist manages our company's best practices to provide vital support to lower claim cost by immediate action of resolution and best possible outcome. Under the direct supervision of a senior claim’s professional, this position will be supporting the goals of the GL claims department. The Claims Specialist will be responsible to conduct thorough investigations, and evaluate and negotiate complex claims including litigation and coverage issues. They will be accountable to ensuring compliance with company Claim Handling Guidelines, including reserving and payment practices.
Roles & Responsibilities
Job Requirements:
Description
Position Summary:
The Claims Specialist manages our company's best practices to provide vital support to lower claim cost by immediate action of resolution and best possible outcome. Under the direct supervision of a senior claim’s professional, this position will be supporting the goals of the GL claims department. The Claims Specialist will be responsible to conduct thorough investigations, and evaluate and negotiate complex claims including litigation and coverage issues. They will be accountable to ensuring compliance with company Claim Handling Guidelines, including reserving and payment practices.
Roles & Responsibilities
- Services the claim needs including insureds, claimants, brokers, etc., in accordance with company policy and procedures.
- Maintains ongoing communication with customer, employee, and adjusters throughout the claims process to provide timely and appropriate claim status as appropriate and/or required by statutory regulations.
- Determines validity and handling including determination of liability through employee and other investigation facts.
- Establishes communication with our stores to ensure the claim is closed timely, by obtaining all relevant information.
- Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority.
- Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and company policy and/or procedures.
- Will strategize with assigned adjuster and defense counsel through litigation for best outcome.
- Handle litigated cases and attends pre-trials, trials, settlement conferences, small claims, and meditations on assigned cases as required.
- Assigns the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the company’s policy.
- Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.
- Maintains regular reporting of case status, developments and direction to the Risk Manager and other appropriate parties as necessary. Ensures timely and appropriate file reports and documentation as required by company claims procedures.
- Investigate possible application of risk transfer, litigation management, appropriate use of vendors,
- Prepare reports and present claims in a round-table setting.
- Adheres to client and carrier guidelines and participates in claims review as needed.
- Able to settle and defend claim as warranted.
- Assists with all stakeholders on matters of corrective action suggestion and collaboration with departments as needed.
- Requires regular and consistent in-person attendance.
- Support with Store visits based on the claim and support to the store management teams.
- Participates and/or manages special projects and assignments as needed.
- Additional projects and duties as assigned.
Job Requirements:
- Bachelor's degree or a combination of education and related experience.
- Minimum of 3 years of industry experience and claims management preferred
- Bilingual Spanish/English
- Excellent written and verbal communication skills.
- Ability to learn rapidly to develop knowledge and understanding of claims practice.
- Ability to identify, analyze and solve problems.
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
- Strong interpersonal, time management and organizational skills.
- Ability to meet or exceed performance competencies
- Ability to work both independently and within a team environment.
Salary : $80,000 - $90,000
