Athens Administrators ยท 1 week ago
Complex Claims Specialist
Lake Mary, FL
Full-time
Hybrid
Senior Level, Lead/Staff
$90K/yr - $126K/yr
10+ years expAthens Administrators is a leader in third-party claims administration services, seeking a Complex Claims Specialist for their Property & Casualty department. The role involves reviewing, investigating, analyzing, and processing complex claims while ensuring quality service delivery to customers.
ComplianceFinancial ServicesInsuranceProperty Insurance
Responsibilities
Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability
Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level
Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management
Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment
Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure
Ensure appropriateness of all coverage memorandums and payments
Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications
Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims
Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities
Provide superior customer service to all layers of authorities within the county
Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account
May assist management in hiring other account dedicated examiners
Provide guidance and serve as a technical expert to less experienced examiners
May conduct meetings or training sessions to help develop less experienced examiners
Attend all required meetings and educational seminars for professional development
Maintain required licenses
Qualification
Required
High School Diploma or equivalent (GED) required for all positions
Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred
Additional State Adjuster License(s), may be required within 180 days
Maintain licenses and continuing education requirements in all states
Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims
Experience with relevant insurance laws, codes, and procedures
Understanding Auto and General Liability exposure and unique coverage endorsements
Understanding of medical, legal terminology and liability concepts
Proficiency in investigation and resolution of severe to major level casualty claims
Time Management and project management skills
Strong negotiation and litigation management skills
Well-developed verbal and written communication skills with strong attention to detail
Excellent organizational skills and ability to multi-task
Ability to type quickly, accurately and for prolonged periods
Proficient in Microsoft Office Suite
Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
Must be able to reliably commute to meetings and events as required by this position
Preferred
AA/AS or BA/BS preferred but not required
Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures
Ability to learn additional computer programs
Benefits
Medical
Vision
Dental
Life and AD&D
Long Term Care
Critical Care
Accidental
Hospital Indemnity
HSA & FSA options
401k (and Roth)
Company-Paid STD & LTD
Company
Athens Administrators
Athens Administrators is an insurance firm that offers worker's compensation, program business, managed care, property & casualty services.
501-1000 employees
Funding
Current Stage
Late StageRecent News
2025-11-09
2025-11-07
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