Complex Claims Specialist

Not Specified
Sep 16, 2020
Nov 15, 2020
Job Type
Not Specified
Career Level
Not Specified


Selective Insurance is seeking a Complex Claims Specialist. The purpose of this position is to provide direct handling of the companys Specialty Claims including Abuse/Molestation, Employment Practices, Directors & Officers and Fiduciary Liability claims.


Responsibilities of this position include coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims. Candidate must possess strong communication and litigation management skills to collaborate with insureds and defense counsel to direct litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The individual in this position will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority with exceptional standards of performance. This individual should possess strategic thought process skills to effectively and efficiently manage loss exposures. Job duties will include communication and collaboration with key stakeholders, training, development and providing thought leadership where requested. The position may require travel to mediations, arbitrations, settlement conferences, trials, training or other proceedings which may account for up to 10% of the specialist time. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

  • Effectively evaluate and resolve coverage issues for all lines of business and all liability claim types.
  • Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information.
  • Effectively and efficiently manage vendors and expenses.
  • Timely analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary.
  • Effectively evaluate, negotiate and resolve claims within delegated authority (ranging from $100,000 to $400,000) utilizing the appropriate denials or releases.
  • Provide required reports to claims, underwriting, reinsurance and actuarial on significant exposure cases.
  • Report on all cases going to trial on a timely basis and attend portions of trials when warranted or where requested by management.
  • Ensure proper referrals and timely updates to appropriate Reinsurer(s).
  • Ability to handle or oversee Extra-Contractual, EPLI, Social Services and E&O claims against the Company.
  • Must be able to drive an automobile to travel within territory. Car travel represents approximately 25% of employees time and a valid drivers license.


  • College degree preferred.
  • 8+ casualty claims handling experience (of those, a minimum of 5 years handling cases of a complex nature with a primary P&C carrier).
  • Experience in complex coverage analysis and claim evaluations;
  • Superior communication and strategic negotiation and claim disposition skills along with proven problem-solving skills;
  • Excellent presentation skills;
  • Moderate proficiency with standard business-related software (including Microsoft Outlook, Work Excel, and PowerPoint.
  • Sufficient keyboarding proficiency to enter data accurately and efficiently
  • Must have valid state-issued drivers license in good standing and be able to drive an automobile.

Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.









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