Primary Job Duties & Responsibilities
Directly handles assigned severity claims. Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
Consults with Manager on use of Claim Coverage Counsel as needed. Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
Complete outside investigation as needed per case specifics. Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
Maintains claim files and documents claim file activities in accordance with established procedures. Utilizes evaluation documentation tools in accordance with department guidelines. Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis.
Utilizes diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability & damages exposure. Establishes and maintains proper indemnity and expense reserves.
Recommends appropriate cases for discussion at roundtable. Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. Develops and employ creative resolution strategies. Responsible for prompt and proper disposition of all claims within delegated authority.
Negotiates disposition of claims with insureds and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Manages litigated claims.
Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, Tracks and controls legal expenses to assure cost-effective resolution. Effectively and efficiently manages
Job Specific & Technical Skills & Competencies
Intermediate Judgment/Decision Making
Intermediate Insurance Contract Knowledge
Advanced Principles of Investigation
Advance Value Determination
Intermediate Settlement Techniques
Intermediate Legal Knowledge
Intermediate Medical Knowledge
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.
Education, Work Experience & Knowledge
Bachelor's Degree preferred. Advanced level knowledge in coverage, contract interpretation, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills preferred.
Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims preferred. Able to make independent decisions on most assigned cases without involvement of supervisor preferred. Thorough understanding of business line products, policy language, exclusions, ISO forms, and effective claims handling practices preferred.
Operates standard office equipment
Continuously Sitting (can stand at will)
Frequently Use of Keyboards, Sporadic 10-Key
Continuously Other (List additional requirements as necessary) Incumbents who fill this position will be subject to periodic post-hire criminal background checks while employed in this position. As a condition of acceptance for the position, selected candidates for this position will be required to electronically accept the Fair Credit Reporting Act (FCRA) Disclosure Statement and Authorization included in the online employment application. You may also be subsequently asked to accept similar FCRA authorizations periodically throughout your employment with the Company.
High School Degree or GED required. In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job.
The Travelers Companies