Complex Claims Specialist

Argo Group and Farm Family are specialty property and casualty insurance brands whose underwriting companies are wholly owned subsidiaries of Brookfield Wealth Solutions, a leading provider of wealth and insurance solutions. Argo and Farm Family partner with agents and brokers to help businesses stay in business, delivering collaborative insurance solutions for niche markets.

Job Description

PURPOSE OF THE JOB:

The Complex Claim Specialist is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure claims. This includes assessing coverage; contacting the insureds, claimants, and witnesses; engaging experts when needed to fully investigate the facts of the loss and to arrive at a proper conclusion in assessing liability and damages. The Complex Claim Specialist is ultimately responsible for liability and coverage decisions, damage assessments and the negotiation of a claim to conclusion. Handling UM/UIM exposures and reviewing litigation strategy and actions of defense counsel for claims involving Arbitration. Provide the insured with the promise of the policy and excellent customer service.

ESSENTIAL FUNCTIONS:

• 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.

ADDITIONAL RESPONSIBILITIES:

• 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.

REQUIRED QUALIFICATIONS:

• Bachelor's degree.

• Six to eight years of experience.

• Supervisory/management experience not applicable.

ADDITIONAL QUALIFICATIONS:

• 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.

PREFERRED QUALIFICATIONS:

• Insurance designations, AIC, SCLA, CLMP, CPCU.

JOB FAMILY:

Level I: Complex Claims Specialist

Salary range is $69,000 - $105,000

Note: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.