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Job Description SummaryUnder general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Auto Liability claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff.
Primary Job Duties & Responsibilities
- CLAIM HANDLING:
- An experienced MCS may have up to reserve/estimate authority of generally $500,000 and payment/settlement authority of $500,000 and generally $500,000 -$2 million total file exposure (full value without regard to coverage or liability defenses).
- Directly handle assigned severe claims.
- Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
- Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
- Complete outside investigation as needed per case specifics.
- Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts.
- Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
- Maintain claim files and document claim file activities in accordance with established procedures.
- Utilize evaluation documentation tools in accordance with department guidelines.
- Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis.
- Utilize diary management system to ensure that all claims are handled timely.
- Establish and maintain proper indemnity and expense reserves.
- Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance.
- Develop and employ creative resolution strategies.
- Responsible for prompt and proper disposition of all claims within delegated authority.
- Negotiate disposition of claims with insureds and claimants or their legal representatives.
- Recognize and implement alternate means of resolution.
- Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
- Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
- Consult with Manager on use of Claim Coverage Counsel as needed.
- Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
- Recommend appropriate cases for discussion at roundtable.
- Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
- OTHER ACCOUNTABILITIES:
- Apply litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
- Track and control.
- In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
- High School Degree or GED required with a minimum of 5 years bodily injury litigation claim handling experience.
Education, Work Experience, & Knowledge
- Bachelor's Degree preferred.
- 5+ years bodily injury litigation claim handling experience.
- Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
- Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims.
- Able to make independent decisions on most assigned cases without involvement of supervisor.
- Thorough understanding of business line products, policy language, exclusions, ISO forms,
- and effective claims handling practices.
Job Specific Technical Skills & Competencies
- Openness to the ideas and expertise of others actively solicits input and shares ideas.
- Strong customer service skills. - Advanced
- Demonstrated coaching, influence and persuasion skills.- Advanced
- Strong written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.- Advanced
- Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. - Advanced
- Attention to detail ensuring accuracy - Advanced
- Job Specific Technical Competencies:
- Analytical Thinking - Advanced
- Judgment/Decision Making - Advanced
- Communication - Advanced
- Negotiation - Advanced
- Insurance Contract Knowledge - Advanced
- Principles of Investigation - Advanced
- Value Determination - Advanced
- Settlement Techniques - Advanced
- Legal Knowledge - Advanced
- Medical Knowledge - Intermediate
Environmental / Work Schedules / Other
- Operates standard office equipment - Continuously
- Sitting (can stand at will) - Continuously
- Standing - Frequently
- Use of Keyboards, Sporadic 10-Key - Continuously
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.