Casualty Claims Rep
Casualty Claims Rep
The CCR will direct the claims management process for all Casualty claims from the first report to closure of the claim. Work closely with a Third-Party Administrator (TPA) to build a strategy for handling of claims and to continually minimize our loss trend. Partner with Legal, Facilities, Store Operations, Leave Administration, and other departments to create solutions for closure of claims and continual program improvement.
- Take lead role in managing TPA relationship for casualty claim issues. Clearly communicate service expectations and negotiate to enforce special service requests to continually improve service.
- Approve assignments of defense counsel, surveillance, special investigations, and experts.
- Monitor TPA's managing of claims through conclusion. Review and approve claim denials as recommended by TPA. Conduct roundtable claim reviews and audits.
- Review reserve notifications and present to GL team in the first 3 months and thereafter provide oversight to TPA on reserve changes between $50,000 and $100,000. Seek agreement for reserves over $50,000 from Casualty Claim Manager by providing TPA's reserve rationale along with an analysis and recommendation.
- Review and approve settlements up to $50,000 after review with Current GL Team. Provide TPA's settlement request and any other documents to management. $ 50,000 in the first 3 months of placement.
- Provide detailed recommendations on all claims valued at more than $50,000.
- Work with stores and others within the company to complete interrogatories and respond to subpoenas.
- Function as a resource to existing claims staff by discussing claim issues, reviewing claim and investigation procedures, answering questions, etc. Work with the existing claims team and QARS Program Manager to build communication to Operations and identify additional training needs based on trends, areas of opportunity and success stories from good investigations.
- Identify trends and work with TPA, Safety Department, QARS Program Manager, Risk Analyst, and others to create solutions for improvement.
- Set plans to meet targets for average number of claims, early resolution settlements, alternative resolution strategies, etc. Track metrics monthly as directed by Claims Manager.
- Focus on Claims to include preparation for and participation in depositions, mediations, and trials. Lead roundtable discussions to obtain best outcomes.
- Undertake and manage special projects as needed and assigned.
- Ability to work well individually as well as in a team environment.
- Excellent oral and written communication skills
- Excellent customer service skills
- Ability to work with little or no supervision.
- Meticulous and excellent organizational skills
- Ability to manage multiple projects simultaneously and independently.
- Excellent interpersonal and presentation skills
- Proven self-starter with demonstrated ability to make decisions.
- Excellent leadership skills
- Proven project management skills
- Bachelor's Degree in a related field preferred. Participation in the relevant industry's Associate in Claims program or an equivalent insurance program. Professional designations, desired.
- Prefer 1-5 years insurance industry experience with at least 3 years of experience as an adjuster or supervisor with an insurance company or Third-Party Administrator (TPA)
- Experience managing claims in a risk management department or experience as a claim consultant or account manager for an insurance company or TPA preferred.
- Ability to use RMIS systems to review adjuster notes and run loss reports to analyze and identify trends.
- Experience in dealing with law firms' claims and complying with the documentary evidence and procedures associated with such claims.
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