Complex Claims Specialist

About this role

Company Farm Family Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Job Description

Business Title(s): Complex Claims Specialist Employment Type: Full-Time FLSA Status: Exempt Location: In Office - Any employee, in any Clearbrook office, can apply for this opportunity and stay in their current location.    

Summary: We are looking for a highly capable Complex Claim Specialist to join our team and work from our Omaha office.  Alternatively, we can fill this position in our Albany, office. We work together in the office five days a week in order to strengthen our culture, build team connections, and drive profitability. 

The position reports to a Claims Manager in Springfield, MO and is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure auto bodily injury claims. This includes assessing coverage; contacting the insureds, claimants, and witnesses; engaging experts when needed to fully investigate the facts of the loss and to arrive at a proper conclusion in assessing liability and damages.  The Complex Claim Specialist is ultimately responsible for liability and coverage decisions, damage assessments and the negotiation of a claim to conclusion. Handling UM/UIM exposures and reviewing litigation strategy and actions of defense counsel for claims involving Arbitration. Provide the insured with the promise of the policy and excellent customer service.    This is a 100% in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.   Essential Responsibilities: • Working under limited technical direction and within broad limits and authority, adjudicate complex and high exposure auto bodily injury claims, potentially with significant impact on departmental results. • Providing laser-focused customer service to our clients by providing superior claims outcomes and developing meaningful and long-lasting connections with our insured and brokers. •  Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage. Address any excess policies that may be applicable to the loss. • Completion of the claim investigation, and/or review of the initial investigation on reassigned files promptly and thoroughly to properly assess and evaluate the liability exposure and to ensure proper reserving for a given exposure in accordance with the company’s reserving philosophy. Secure recorded statements from all parties; document file activity in a concise and comprehensive manner. • Adjudicating claims that have the greatest complexity and severity, with the highest exposure to the company and to the insured, which may include excess umbrella policies. • Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution. • Completion of claim evaluations with settlement authority recommendations and present those recommendations to upper management. • Identifying, assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution. • Negotiation of claims to a proper resolution within the authority extended. Attend mediations if as and when required.Handling all fatality and pedestrian losses. • Proactively move files toward a proper resolution. • Establish and maintain an appropriate diary on all files. • Consult with defense counsel or medical experts if needed.  • Applies cost containment methodology, when appropriate, claim review for medical necessity and reasonable and customary charges. Utilizing third party bill reviews when applicable.  • Report to Underwriting when information is developed requiring a risk analysis of the policy.  • Communicate with agents, providing updates, inquiries and alerts. • Adjudicate claims according to applicable state mandates/statutes; investigate, review and stay current on applicable case law. • Demonstrates responsibility in making liability assessments for first- and third-party losses, send required forms and state compliance documents/letters. • Obtain appropriate releases, court approved settlements for minors, or estate claims, structured settlements. • Attend pre-suit mediations. • Handle demands for Arbitrations and discovery associated with those claims. • Ensure compliance with state regulations and requirements. • Considers alternative dispute resolutions, utilizing creative resolutions when appropriate, to reach an effective resolution of a dispute. • Makes daily decisions to determine the appropriate course of action for the file, considering the exposure of the insured, the company, cost, and risk factors. • Having an appreciation and passion for strong claim management.

Qualifications / Experience Required: • A specialized knowledge of adjudicating complex and high exposure auto bodily injury claims, including fatalities, as well as exceptional customer service focus, typically achieved through: • A minimum of five years’ of experience adjudicating complex and high exposure auto bodily injury claims. • Bachelor's degree from an accredited university required. Two or more industry designations or four years of relevant experience in addition to those mentioned above can be substituted for a bachelor’s degree. • Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days

• Must have good business acumen (i.e. understand how an insurance company wor

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