Predictive Severity Specialist
- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
The Predictive Severity Specialist is an experienced claims adjuster and subject matter expert in processes, procedures, workflow, handling complex claims, and technical knowledge. They will be responsible for analyzing key metrics and predictive severity reports to identify files for reassignment, appropriate reserving, and resolution strategies.
ESSENTIAL JOB RESPONSIBILITIES:
- Responsible for handling a minimal caseload
- Review and analyze predictive severity model to insure claims are assigned to the appropriate staff.
- Provide oversight, in conjunction with the managers, on reportable claims
- Act as a liaison for adjusters and unit managers on complex level claims or claims in that may be considered specialized
- Investigate & evaluate cases including insurance coverage based on initial report, the insurance policy, applicable statutes, and case law to determine if a claim can be accepted as within coverage
- Conduct spot reviews and/ or quality checks on claims
- Actively seek out and communicate with the Unit Manager of any potential opportunities to improve or automate workflow/ processes
- Serve as a subject matter expert for Claims Adjusters and CSRs on procedures and workflow
- Assist with special projects or assignments as necessary including supporting the team as backup when needed
- As a subject matter expert, continue to build upon specialized knowledge of complex and unique areas
Obtain and maintain all required licenses and certifications
Ability to review, analyze, and interpret data accurately within a timely manner
Excellent time and organizational management skills
Strong written and verbal communication skills
Ability to lead by example
Complete understanding of Claims Handling process and organization and ability to recognize gaps in execution and create action plans to fill those gaps
Strong knowledge of Casualty Claims and Regulations for relevant jurisdictions as well as practices & procedures and current case law
In-depth knowledge of Yorks Best Practices and client Account Instructions
Advanced working knowledge of Yorks claim system and internal workflows & procedures
ROUTINE DECISIONS AND FORMAL POLICY SETTING:
Utilize data to identify optimization opportunities and drive strategic initiatives
Identify and partner with leadership on identifying training opportunities
When gaps in Claims Handling are identified, when to directly fix issues, inform person accountable or escalate the matter
The position does require the incumbent to make informed decisions related to their daily responsibilities.
No formal responsibility for setting policy associated with the jobs purpose.
BS / BA or Equivalent Work Experience
Minimum 5 years of claims experience/ relevant experience