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The Claim Specialist investigates, evaluates, and resolves Commercial General Liability and Commercial Automobile Liability claims.
Extensive knowledge of policy documents and legal contract interpretation.
Working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management.
Litigation handling experience in both General Liability and Casualty
Present file materials for authority and roundtables.
Work with nurses, doctors, and attorneys on file reviews.
Comply with all statutory and regulatory requirements of all applicable jurisdictions.
Meet detailed quality assurance standards and meet set goals of performance.
Set and revise case reserves in accordance to the reserving policy.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Partner closely with internal teams and advises leadership of key claim activities and exposures.
Qualifications - Highly technical knowledge as demonstrated with at least 13+ years of directly related experience.