Complex Claims Manager

Job Description

Complex Claims Manager supervises a team of Claims Senior Representatives and Complex Claims Lead Adjusters that process complex claims adjustment and resolution.

The role works with experts to evaluate large and complex damage claims, negotiating maximum contributions to effect timely and equitable settlements, and establishes timely, appropriate reserves for legal and indemnity exposures.

The role also drives appropriate resolution of complex claims having a significant financial impact and / or producing high corporate visibility.

Responsibilities

• Assists in developing and executing strategic direction of complex claims, ensures consistent delivery of claims practices, resources, tools, and performance, and drives strategic and organizational results through appropriate vendor and process solutions / applications.
• Supervises Westfield's larger losses and complex claims, including the adjustment and resolution of Westfield's referred claim files.
• Analyzes insurance policies, legal procedures, legislation, and court opinions and serves as a technical subject matter expert in complex claims, maintaining the overall quality of complex claim files.
• Establishes timely and appropriate reserves for legal and indemnity exposures and manages severity exposures by identifying and reporting them, and develops investigation, evaluation, and resolution strategies.
• Authorizes reserve and settlement authority, directs defense counsel, and monitors cases with financial impact through trial.
• Interprets and applies primary and excess policy provisions according to the laws in states and manages outside counsel and adheres to individual authority grants, statutory and regulatory requirements, fair claim practices, and local compliance requirements, including licensing.
• Evaluates large and complex claims, manages outside counsel, and reviews case documents, and negotiates contributions to effect timely and equitable settlements and documents efforts and conclusions.
• Serves as a technical consultant to claims staff in the assigned territory, business partners, quality assurance, and related industry groups.
• Provides expertise in policy language creation and review and may contribute to the selection of vendors, new markets, and product enhancements.
• Maintains effective and ongoing communication with claims staff, internal and external business partners, project team members, claims leadership, and vendors and serves as a subject matter expert to the various business units regarding complex claims.
• Gathers, organizes, and analyzes performance data and results to identify and report performance, trends, and opportunities;

makes recommendations regarding areas of improvement.

• Creates reports and communicates results with claims leadership, agents, and business partners.
• Provides exceptional service to internal and external business partners and recognizes potential significant exposures on claims and prepares appropriate alerts to senior managers and internal business partners.
• Participates in complex claim exposure analysis and strategy discussions, collaborates with leaders to identify emerging trends, and develops new mitigation strategies.
• Gathers, organizes, and analyzes performance data to identify areas of improvement and communicates results to claims leadership and business partners and partners with vendor / process managers to ensure timely claim file and vendor audits and prompt issue resolution.
• Handles talent management responsibilities as well as operational responsibilities like planning, process improvement, and ensuring work quality and customer service, assists with business planning and budgeting, and identifies risk and mitigation strategies related to complex claims and other processes.
• Stays current on industry topics, trends, processes, and technology, shares knowledge with others to drive new and updated policies, processes, and procedures, and trains, develops, and manages a team of claims professionals, creating individual professional development plans for each team member.

Qualifications

• 7+ years of experience complex claims handling or a related field.
• Bachelor's degree in business or a related field and / or commensurate work experience
16 days ago