PIP Litigation Specialist
- Career Level
- Not Specified
Responsible for handling secondary or transferred claims on high exposure and/or complex losses in which initial work was completed by other claims representative. Review claim for accuracy and completion with regard to investigation into facts of loss, coverage and liability, settlement value, settlement options and plan of action recommended from reassigning party. Assist in training, developing and mentoring of Claim Representatives, along with acting as subject matter expert in the handling of complex and/or legal claim issues.
Essential Duties and Responsibilities:
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
- Review claims for accuracy and completion with regard to investigation into facts of loss, coverage and liability, settlement value, settlement options and plan of action recommended from reassigning party; determine if additional investigation, medical documentation or work is needed; determine settlement value and settlement options and negotiate injury claims of a serious and complex nature within authority granted
- Establish liability investigation plan with telephone claims representative on initial losses received; when needed, assist in the investigation by gathering facts and evidence with all witnesses and interested parties, take recorded statements, analyze extent of property damage and review loss reserves, adjusts and/or opens hidden exposures
- Determine if potential subrogation or fraud issues exist and refer to appropriate claim unit for handling, with recommendation on plan of action, or may independently determine to handle issues to conclusion
- Gather, analyze and evaluate for settlement purposes all supportive medical documentation which may include obtaining medical authorizations, medical and lost wage records
- Handle claims in litigation which includes demonstrating knowledge of the litigation process, knowledge of applicable National General litigation policies and procedures and interpreting and applying this knowledge to claims in litigation; determine whether to negotiate settlements directly with plaintiff counsel or refer to defense counsel; manage litigation and recovery costs; utilize ADR when appropriate
- Assist in training, developing and mentoring of Claim Representatives as needed
- Act as subject matter expert in regard to complex and/or legal claim handling issues
- Prepare for and attend legal case mediation and settlement conferences as necessary
- Assist with file audits, research projects and other assignments as needed
- Assist management with organizing, facilitating and participating in file roundtables as needed
- Assume leadership role in the absence of management
Required Skills and Competencies:
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Bachelors Degree or in-lieu of degree equivalent education, training and work-related experience
- Obtain/Maintain appropriate licensing or education requirements
- Possess ability to work independently with minimal to no supervision on complex and litigated files
- Demonstrate strong understanding in file audits to agreed standard of efficient claims quality
- Demonstrate a solid command of the claims policies and procedures, in addition to, the interpretation of policies and procedures in resolving claims
- Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan
- Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures
- For claims involving injuries, has solid understanding of how to review, evaluate and negotiate injury claims
- Possess a thorough command, understanding and knowledge of state laws, regulations and NGI Claims Handling Guidelines applicable to claims handled, including state unfair claim practice laws
- Demonstrate ability to handle litigation in accordance with company guidelines and be able to recognize legal issues; ability to utilize ADR when appropriate
- Possess a high degree of initiative, independent judgment and discretion
- Ability to resolve conflicts and empathize with customers
- Possess negotiation skills to use in resolving claims
- Possess professional verbal and written communication skills
- Possess solid skills in organization and time management
- Possess expertise in insurance law and able to interpret and apply these laws as it relates to claims
- Demonstrate a proficient application of the insurance industry and organizational relationships of the company; demonstrate an understanding of the functions of other departments such as Policy Ops and Marketing
- Possess effective leadership and mentoring skills
- Successful completion of one or more professional designations: AEIs Legal Principals or completion of the Associate in Claims designation (AIC 33, 34, 35, 36), CPCU, SCLA (Senior Claims Law Associate), FCLS (Fraud), PCLS (Property), CCLS (Casualty), LPCS (Legal Principles) and JD
About National General Holdings:
National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!
Companies and Partners
Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.
In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:
Medical, Dental, Vision benefits
Life and Short/Long Term Disability Insurance
401k w/ Company Match
Company Paid Holidays & Generous Time-off policy
Employee Discount Program
Career Advancement and Development Opportunities
On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
On-site Fitness Center (Cleveland and Dallas offices)
Subsidized parking (Cleveland office)
National General Holdings Corp. is an Equal Opportunity (EO) employer Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.