Key Responsibilities:
- Maintains claim load of litigated and non-litigated claims.
- Investigates and verifies coverage; investigates losses by gathering all pertinent information; issues coverage determinations; and consults with in-house coverage counsel as appropriate.
- Investigates, evaluates, and adjusts assigned claims in accordance with all company policies and procedures, with all applicable laws and regulations, and within assigned authority. May use independent adjusters to assist in claim investigations as appropriate.
- Exercises independent decision-making with minimal to moderate supervision and direction on assigned claims, using knowledge of applicable codes, laws, standards, and regulations.
- For litigated claims, assigns defense counsel and ensures cases are handled effectively and efficiently until final resolution through settlement or judgment. Collaborates with panel counsel on claims strategy and ensures counsel is complying with the company’s outside counsel guidelines.
- Prepares and presents claim recommendations to upper management.
- Investigates and identifies all sources of recovery and subrogation for assigned claims.
- When necessary and appropriate, attends mediations, arbitrations, or trials on assigned claims.
- Works with SIU to protect the company from false or inflated claims.
- Ensures information in claim files is timely documented, accurate, current, and complete.
- Maintains active tasks for assigned claims files, with the current plan of action.
- Responds to insureds and third parties in a prompt, courteous, and professional manner.
- Relays status of claims to insureds in a timely manner.
- Researches and resolves problems, questions, or concerns or refers them to management as appropriate.
- Attends meetings and training as necessary.
- Keeps management and underwriting team apprised of developments and emerging trends.
- Handles special projects and additional responsibilities as assigned.
Job Requirements:
- Bachelor’s Degree required.
- Required insurance certifications and licenses. If not licensed, must complete licensure within 60 days of employment.
- Minimum 5-10 years of related professional experience handling auto and casualty claims. Prior litigation management experience preferred. Understanding of general legal concepts is required. Comprehensive knowledge of insurance policies and the ability to understand complex documents is required.
- Strong interpersonal and public relations skills.
- Effective communication skills.
- Solid analytical skills.
- Ability to identify and understand coverage issues with good knowledge of exclusions and endorsements.
- Good organizational, problem-solving, and prioritization skills.
- Ability to use related office and computer equipment and administrative claims systems with training.
Universal Shield Insurance Group offers a competitive benefits package that supports employees’ health, wellness, financial well-being, and work-life balance. Benefits include medical coverage with company-contributed HSA, dental and vision insurance, company-matched 401(k), and optional voluntary benefits.