Senior Claims Specialist - Insurance Company
Company Overview
At Tuarial, we pride ourselves on delivering exceptional claims service to our policyholders during their time of need. With a commitment to integrity, fairness, and customer satisfaction, we're seeking an experienced Senior Claims Specialist to join our dedicated claims team.
Job Overview
The Senior Claims Specialist is responsible for managing complex claims from initial notification through final resolution. This role requires expert-level knowledge of insurance coverage, liability assessment, and claims handling procedures. The ideal candidate will demonstrate superior investigative abilities, strong negotiation skills, and a commitment to fair claims resolution while protecting the company's interests.
Key Responsibilities
Claims Investigation & Resolution
- Manage, investigate, and resolve complex insurance claims across assigned lines of business
- Investigate and evaluate coverage, liability, and damages according to policy terms and applicable laws
- Settle claims within prescribed procedures and authority limits
- Recommend appropriate resolution on complex cases that exceed personal authority to local claims management and Home Office
- Identify potentially suspicious claims and refer them to the Special Investigation Unit (SIU)
- Recognize opportunities for third-party subrogation and initiate appropriate recovery actions
Legal Proceedings & Representation
- Prepare for and attend trials, hearings, and conferences as required
- Provide detailed status reports to Home Office and local management
- Confer with defense counsel on litigation strategy and case development
- Prepare comprehensive trial reports and litigation analyses
- May represent the company on matters involving state or federal regulatory agencies in the absence of the Claims Team Manager
Policyholder & Claimant Communication
- Conduct professional communication with policyholders, witnesses, and claimants to gather relevant claim information
- Refer tasks to auxiliary resources as necessary to ensure efficient claim handling
- Advise stakeholders on proper courses of action throughout the claims process
- Respond promptly to various written and telephone inquiries, including status reports
- Maintain clear documentation of all claim-related communications
Financial Management
- Ensure accuracy and adequacy of claim reserves based on thorough evaluation
- Recommend reserve increases on cases exceeding personal authority limits
- Maintain accountability for secure financial processing of claims
- Monitor and manage the practices and billing activities of outside and in-house counsel
- Ensure protection of confidential information contained in claims files
Professional Development & Special Projects
- Participate in special projects as assigned by management
- Mentor less experienced claims professionals when requested
- Stay current with evolving industry practices, regulatory changes, and case law
Required Qualifications
- Bachelor's degree or equivalent experience
- Minimum of 7 years of directly related claims handling experience
- Expert knowledge of insurance coverage, liability assessment, and complex claims handling procedures
- Full working knowledge of claims operations and procedures
- Comprehensive understanding of state and federal laws in the adjuster's jurisdiction
- Excellent written and oral communication skills
- Strong interpersonal, analytical, investigative, and negotiation abilities
- Ability to obtain and maintain appropriate adjuster licensing as required by state regulations
Preferred Qualifications
- Industry designations such as AIC, CPCU, or similar credentials
- Experience with multiple lines of insurance (auto, property, liability, etc.)
- Background in handling high-value or complex litigation claims
- Knowledge of insurance fraud indicators and investigation techniques
- Experience with claims management systems and digital claims processes
Benefits
- Competitive salary and performance-based incentives
- Comprehensive health, dental, and vision insurance
- Retirement savings plan with company match
- Professional development and continuing education support
- Paid time off and company holidays
- Career advancement opportunities
Tuarial is an Equal Opportunity Employer committed to diversity and inclusion in the workplace.