Job Title:   Casualty Complex Claims Specialist
04 / 11 / 2013
Lake Mary
FL

JOB DESCRIPTION:

JOB TITLE: Claims Specialist - Casualty Complex
 
DEPARTMENT: Claims
UNIT: Casualty Complex Claims
REPORTS TO: Unit Leader – Casualty Complex Claims
FLSA: E
 
 
JOB SUMMARY:-Supervises and or directly handles Westfield’s largest and most complex casualty claims, typically in excess of $250,000, and having significant financial impact and/or producing high corporate visibility.  Participates in complex and large exposure analysis and strategies through roundtable discussions.  Serves as casualty complex claims technical consultant to business partners.
 
A.  ESSENTIAL FUNCTIONS(Listed in order of importance, frequency or sequence, 1=most important/frequent, etc.).
 
 

  1. Referred File Supervision - Responsible for Westfield’s largest and most complex casualty claims, including direct or indirect supervision of activities surrounding the adjustment and resolution of Westfield’s casualty referred claim files, typically in excess of $250,000.  Responsible for the appropriate resolution of complex claims having a significant financial impact and/or producing high corporate visibility without any regard to geographic location, size or type of casualty claim.
  2. Claim File Handling - Directly handles Westfield’s largest and most complex claims, typically in excess of $250,000.  Responsible for the appropriate resolution of assigned complex claims having a significant financial impact and/or producing high corporate visibility and without any regard to geographic location, size or type of casualty claim.
  3. File Exposure Analysis - Participates in complex and large exposure analysis and strategies through roundtable discussions with home office and field operations.
  4. SME - Serves as casualty complex claims technical consultant to business partners, Quality Assurance & Compliance, and related industry groups to identify and communicate reserving and industry activity and trends and to update claims management process, programs and tools.  May participate in policy language creation and review, selection of vendors, selection of new markets and selection of product enhancements. 
  5. Communication - Maintains effective and ongoing communication with claims staff, internal and external business partners, project team members, claims leadership, and vendors.  May serve as a subject matter expert to the various business units regarding casualty complex claims.
  6. Collaboration - Partners with various business units and corporate cross-functional teams (Underwriting, Risk Services, Westfield University, R&D, Claims Legal, etc.) to develop, implement, train and manage various line of business claims initiatives and programs to improve unit, department, and company performance.
  7. Customer Service - Ensures customer service excellence.  Responsible for the customer, agent and claims professional experience associated with casualty complex claims. 
  8. Industry Best Practices - Participates in professional industry groups and stays abreast of industry changes and advancements to communicate, develop, and incorporate best practices into the claims business.  Shares new information, best practices, and processes.  
  9. Leader Assistance - May assist leader with data analysis, risk identification, business planning, processes and budget.
  10. Reinsurance Reporting - Reports claims that are within reinsurance and errors and omissions agreements, and pursues reimbursement.  Prepares detailed reports for senior management and reinsurers.

 
 

  1. Training - Collaborates with casualty management team in the identification of casualty training needs.  May partner with Westfield University to design, develop, and deliver training programs to claims professionals.
  2. Performs other duties as assigned.

 
B.  JOB SPECIFICATIONS/EXPERIENCE/CERTIFICATION/EDUCATION (in order of importance):
 

  1. 7 or more years of casualty claims handling experience of accurately evaluating, negotiating, and settling casualty claims of all severity levels.  Demonstrated technical expertise in casualty claims.
  2. 3 or more years of experience regularly handling complex casualty claims (potential exposures in excess of $250,000 or specialty areas).
  3. Excellent oral, written and interpersonal skills, resulting in the ability to interact with all levels of management and employee population.
  4. Excellent analytical, tracking, and monitoring skills.  Ability to collect and analyze data, identify trends, establish facts, and recommend solutions.
  5. Strong organization and facilitation skills.
  6. Proficient use of various core systems, office and computer equipment and software packages.
  7. Conflict resolution experience.
  8. Travel.
  9. Valid driver’s license and a driving record that conforms to company standards.
  10. Industry recognized designation, such as CPCU, SCLA, AIC, etc.
  11. Bachelor’s Degree.

C. PHYSICAL REQUIREMENTS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 
 

  1. Ability to work effectively in an office environment for 40+ hours per week (including sitting, standing and working on a computer for extended periods of time).
  2. Ability to communicate effectively in a collaborative work environment utilizing various technologies such as:  telephone, computer, web, voice, teleconferencing, e-mail etc.
  3. Ability to travel as required.
  4. Ability to operate an automobile within the parameters of the driving policy.

 
D.  SUPERVISES:
      Supervises field claims staff on an individual file basis.
  
 

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