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James River Insurance Company · 1 day ago

Claims Specialist - Executive Claims Specialist - Coverage - Claims-Made

United States

Full-time

Remote

Senior Level

7+ years exp

James River Insurance Company is an excess and surplus lines segment of James River Group Holdings, Ltd., known for providing innovative insurance solutions since 2003. The Claims Specialist/Executive Claims Specialist will manage high complexity commercial insurance claims, focusing on Allied Health, while ensuring compliance with state regulations and providing exceptional customer service.

FinanceFinancial ServicesInsurance

No H1B

Responsibilities

Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service

Perform coverage, liability, and damage analysis on all claims assignments

Investigate allegations, determine facts based on evidence and interviews

Draft disclaimers and reservation of rights letters when coverage issues arise

Assign limited investigations and appraisals to independent licensed professionals

Manage a caseload of high complexity claims with delegated authority

Manage litigated files

Negotiate settlements, mitigate losses, and control expenses

Participate in and attend mediations to facilitate settlements

Maintain accurate documentation in claim files

Maintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokers

Act as a consultant providing technical expertise within specialty area to internal stakeholders

Provide technical guidance, assistance and training as needed for less experienced Claims professionals

Maintain a passing quality assurance score on all audits and QAs

Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status

Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity

Handle claims in accordance with established James River Claims Best Practices

Other duties as required by management

Qualification

Claims handling expertiseP&C insurance knowledgeRisk assessmentMS Office proficiencyNegotiation skillsAnalytical skillsCustomer serviceTechnical guidanceJudgmentWritten communicationVerbal communicationOrganizational skillsTeamworkProblem-solving skillsAttention to detail

Required

High school diploma required

Minimum of seven years of experience handling primary and excess claims-made and occurrence liability policies and claims for Claims Specialist

Minimum of ten years of experience handling primary and excess claims-made and occurrence liability policies and claims for Executive Claims Specialist

Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims

Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills

Adjuster license and/or certifications desired for Claims Specialist

Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL) for Executive Claims Specialist

Project management and process implementation experience for Executive Claims Specialist

Expert level of expertise in claim handling and suit management

Expert knowledge of P&C insurance industry

Expert ability to effectively assess risk

Proficiency in MS Office (Word, Excel, Outlook)

Excellent written and verbal communication skills

Advanced analytical and organizational skills

Advanced negotiation skills

Ability to work independently and take initiative

Ability to exercise sound judgement in making critical decisions

Research, analysis and problem-solving skills

Ability to work in a team environment and accept feedback from Claims management

Ability to build effective relationships with business partners

Ability to organize complex information and pay close attention to detail

Ability to anticipate customer needs and take initiative to meet those needs

Ability to train and provide technical guidance to less experienced Claims professionals

Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter