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Become A Senior Claims Specialist

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Working As A Senior Claims Specialist

  • Identifying Objects, Actions, and Events
  • Interacting With Computers
  • Getting Information
  • Documenting/Recording Information
  • Processing Information
  • Unpleasant/Angry People

  • Mostly Sitting

  • Make Decisions

  • Stressful

  • $62,980

    Average Salary

What Does A Senior Claims Specialist Do At Utica National Insurance Group

* Include performing all duties and responsibilities as outlined for Claims Specialist;.
* Investigating and handling all multiple lines claims of a complex and serious nature.
* Performing special claims investigation and handling matters requiring broad technical claims knowledge.
* Operating on an independent basis with little supervision.
* Settling claims within assigned authority.
* Numerous contact with attorneys concerning serious claim matters.
* Reviewing court decisions, law and coverage interpretations.
* Broad knowledge and understanding of the law and claim practices.
* May assume duties of the Claims Supervisor in the Supervisor's absence

What Does A Senior Claims Specialist Do At Liberty Mutual

* Reviews and administratively sets-up claims in software tracking system and writes or revises the brief description of loss to ensure that it accurately reflects the actual circumstances.
* Acts as senior technical professional on team, assisting team members with escalated issues.
* Mentors and trains new team members.
* Participates in Quality Review process.
* Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
* Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners.
* Determines and documents, during the investigation process, the potential for subrogation, identifying applicable tort feasors and promptly placing them "on notice" of claim; refers claims to subrogation group upon recognition of potential recovery.
* Evaluates claims for potential fraud and makes referrals to the Special Investigations Unit as appropriate.
* Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
* Alerts underwriting, marketing and/or risk management regarding questionable risks encountered to ensure that potential hazards are clearly documented.
* May coordinate elements of litigation efforts, or assume direct responsibility for select litigation efforts for development purposes, associated with assigned claims to ensure a timely and cost-effective resolution; may attend trails as a company representative.
* Participates in the training of, and serves as a technical resource for, less experienced claims personnel.
* May participate in conducting Suit Committees, Roundtables, Arbitrations, Mediations and field investigations

What Does A Senior Claims Specialist Do At Combined Insurance

* Duties include but are not limited to:
* Day to day handling of an inventory of approximately 135 personal and/or commercial liability claims, largely comprised of claims involving moderate to high exposures and/or coverage issues, across multiple lines of business.
* Independently carry out claim handling activities including, but not limited to, coverage analysis, investigation of liability and damages, litigation and expense management, evaluate claims for reserve and settlement, execute settlement strategy and proactively negotiate settlements, attend mediations/arbitrations, and ensure appropriate file documentation.
* Review and analyze contracts for risk transfer potential.
* Proper file documentation and diary management.
* Provide superior claim handling and customer service.
* Adhere to Best Practices Guidelines.
* Vendor and expert management subject to established guidelines and procedures.
* Demonstrate and implement effective defense, resolution and claim strategies.
* Attend settlement conferences, arbitrations and mediations as appropriate.
* Adhere to individual authority grants, all statutory and regulatory requirements, fair claim practices and local compliance requirements, including examiner licensing.
* Automobile (AL) and General Liability (GL) with experience in AL Bodily Injury and GL Products & Premises Liability.
* Strong background and demonstrated ability in handling claims involving the New York Labor Law and NY Insurance Law 3420(d).
* Experience handling claims in NY, NJ, PA, DE, MD, VA and WV is strongly preferred.
* Strong background and demonstrated ability in dealing with significant coverage matters.
* An understanding of the tenants of insurance and legal principles.
* Excellent verbal, written and interpersonal communication and negotiation skills.
* An ability to work independently and assimilate learning materials on many different subjects from various sources.
* Strong time management, litigation management and multi-tasking skills.
* Working knowledge of industry best practices and procedures.
* Excellent interpersonal communication and negotiation skills; and an ability to deal with internal and external customers and business partners in a professional manner.
* Ability to make prompt, intelligent decisions based upon detailed analysis of complex issues.
* Demonstrate strong relational skills particularly in adverse or high-pressure situations.
* A law degree is not required.
* Insurance licensing in DE and WV is preferred.
* Write coverage position letters

What Does A Senior Claims Specialist Do At Philadelphia Insurance Companies

* Evaluates each claim in light of facts, policy considerations and corporate direction
* Pays and/or reserves and/or denies coverage as appropriate
* Investigates circumstances of routine as well as complex claims to determine if and to what extent coverage applies
* Communicates with all relevant parties and documents communication as well as results of investigation
* Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts

What Does A Senior Claims Specialist Do At Combined Insurance

* Duties may include, but are not limited to:
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
* Analyzes coverage and communicates coverage positions, as warranted, under direction of supervisor and coverage unit.
* Conducts, coordinates, and directs investigation into loss facts and extent of third-party damages.
* Directs and monitors assignments to experts and underlying defense counsel.
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
* Sets reserves within authority or makes claim recommendations concerning reserve changes to supervisor.
* Reports to reinsurers and facilitates the prompt collection of reinsurance on those matters where they are accountable.
* Travels to conferences, mediations, and trials as necessary

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How To Become A Senior Claims Specialist

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher level positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

The varying types of work in these occupations can require different backgrounds or different college coursework. For example, a business or an accounting background might be best for someone who wishes to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have the formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Most insurance companies prefer to hire people trained as law enforcement officers, private investigators, claims adjusters, or examiners, because these workers have good interviewing and interrogation skills.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims, under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must both evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

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Senior Claims Specialist jobs

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Senior Claims Specialist Demographics

Gender

  • Female

    61.7%
  • Male

    36.3%
  • Unknown

    2.1%

Ethnicity

  • White

    82.0%
  • Hispanic or Latino

    9.5%
  • Asian

    6.2%
  • Unknown

    1.7%
  • Black or African American

    0.6%
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Languages Spoken

  • Spanish

    68.2%
  • Portuguese

    9.1%
  • Chinese

    4.5%
  • French

    4.5%
  • Carrier

    4.5%
  • Hebrew

    4.5%
  • Mandarin

    4.5%
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Senior Claims Specialist

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Senior Claims Specialist Education

Senior Claims Specialist

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Top Skills for A Senior Claims Specialist

ComplexCoverageIssuesCustomerServiceLossAutoClaimsGeneralLiabilityClaimsTermDisabilityProcessClaimsIndependentAdjustersBodilyInjuryClaimsWorkersCompensationClaimsFraudulentClaimsPropertyDamageClaimsComplexClaimsDefenseCounselInsuranceClaimsMedicalClaimsMedicalTreatmentAuditCaseloadSpecialInvestigationUnit

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Top Senior Claims Specialist Skills

  1. Complex Coverage Issues
  2. Customer Service
  3. Loss
You can check out examples of real life uses of top skills on resumes here:
  • Reviewed, analyzed and resolved complex coverage issues under ISO and manuscript forms.
  • Provide customer service to all policyholders.
  • Serviced policy holders after accident and/or vehicle thefts of total loss vehicles, by generating written damage estimates using specialized software.
  • Resolved auto claims with high levels of file quality, file accuracy, cycle time and customer service.
  • Managed and negotiated automobile and general liability claims settlements for both personal and commercial policyholders with an emphasis on bodily injury.

Top Senior Claims Specialist Employers