American National · 13 hours ago
Complex Claims Specialist
US NE - Omaha
Full-time
Onsite
Mid, Senior Level
$69K/yr - $105K/yr
6+ years expAmerican National is a leading provider of wealth and insurance solutions. The Complex Claims Specialist is responsible for investigating, evaluating, negotiating, and settling complex claims, ensuring compliance with coverage and liability assessments, while delivering excellent customer service.
Auto InsuranceFinancial ServicesHealth CareHealth InsuranceInsuranceLife Insurance
No H1B
Responsibilities
Completion of an initial review and analysis of the policy coverage to determine if coverage is applicable. Address any excess policies that may be applicable to the loss
Completion of the claim investigation, and/or review of the initial investigation on reassigned files to property assess and evaluate the liability exposure and to ensure proper reserving for a given exposure in accordance with the company’s reserving philosophy. Secure recorded statements from all parties; document file activity in a concise and comprehensive manner
Handling claims that have the greatest complexity and severity, with the highest exposure to the company and to the insured, which may include excess umbrella policies
Completion of claim evaluations with settlement authority recommendations and present those recommendations to upper management
Negotiation of claims to a proper resolution within the authority extended. Attend mediations if as and when required
Handling all fatality and pedestrian losses
Proactively move files toward a proper resolution
Establish and maintain an appropriate diary on all files
Consult with defense counsel or medical experts if needed
Applies cost containment methodology, when appropriate, claim review for medical necessity and reasonable and customary charges. Utilizing third party bill reviews when applicable
Report to Underwriting when information is developed requiring a risk analysis of the policy
Communicate with agents, providing updates, inquiries and alerts
Process claims according to applicable state mandates/statutes; investigate, review and stay current on applicable case law
Demonstrates responsibility in making liability assessments for first- and third-party losses, send required forms and state compliance documents/letters
Obtain appropriate releases, court approved settlements for minors, or estate claims, structured settlements
Attend pre-suit mediations
Handle demands for Arbitrations and discovery associated with those claims
Ensure compliance with state regulations and requirements
Considers alternative dispute resolutions, utilizing creative resolutions when appropriate, to reach an effective resolution of a dispute
Makes daily decisions to determine the appropriate course of action for the file, considering the exposure of the insured, the company, cost, and risk factors
Qualification
Required
Bachelor's degree
Six to eight years of experience
Supervisory/management experience not applicable
Preferred
Insurance designations, AIC, SCLA, CLMP, CPCU
Completion of the appropriate insurance designation
Training on Medical Terminology
Maintain continuing education (CE) requirements for state licensing
Documented history of successfully handling complex, high exposure claims
Documented proficiency in written and verbal communication
Benefits
Health
Dental
Vision
401(k) with company match
Paid time off
Professional development opportunities
Company
American National
American National is an insurance company that provides life insurance, health insurance, and auto insurance services.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2021-08-09Acquired
Leadership Team
M
Matthew Ostiguy
Senior Vice President, P&C Chief Operating Officer, American National Insurance Company
Recent News
2025-12-01
2025-12-01
American National Insurance, LLC
2025-10-31
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