Claims Specialist

Summary

Join NEXT Insurance as a Claims Specialist and become a subject matter expert in the Claims department, handling high-severity and high-complexity commercial claims. You will lead department roundtables and mentor other team members. Responsibilities include extensive policy document interpretation, claims investigation and resolution, litigation handling, communication with stakeholders, and compliance with regulations. The ideal candidate possesses a BS/BA degree, 10+ years of relevant experience, strong communication and analytical skills, and a Texas Independent Adjuster License (or ability to obtain one). NEXT offers a competitive salary, benefits package, and a collaborative work environment. We encourage applications from diverse candidates, even if they don't meet every requirement.

Requirements

• BS/BA Degree required
• At least 10+ years of directly related experience with Commercial General Liability and Litigation
• Strong written and oral communication skills required, as well as strong interpersonal, analytical, investigative, and negotiation skills
• In-depth knowledge of multi-jurisdictional claims handling issues
• Willingness to utilize and adapt to evolving technologies within the Claims operations
• Must be a self-starter and able to work independently
• Candidates must have, or be able to promptly obtain, a Texas Independent Adjuster License
• Effective communication, presentation, negotiation, and persuasion skills
• Ability to collaborate with cross-functional teams to achieve business results
• Proven success in delivering strong results in a rapidly changing claims environment
• Someone who achieves a standard of excellence with work processes and outcomes, honoring company policies and regulatory compliance
• Team orientation that emphasizes building strong working relationships and contributing to a positive work environment
• High degree of comfort with navigating sometimes ambiguous environments and a willingness to dive in and assist coworkers with workloads or contribute to organizational needs/projects when needed
• Receptivity to feedback and a willingness to learn, embracing continuous improvement, and having an openness to learning new and evolving proprietary and off-the-shelf software systems
• Some travel capability, likely up to 10% of capability

Responsibilities

• Extensive policy document and legal contract interpretation
• Ability to analyze and identify coverage and related coverage issues
• Leverage a working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims
• Manage, investigate, and resolve claims within prescribed authority levels
• Recommend ultimate resolution on assigned cases in excess of authority to claims management
• Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims
• Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues
• Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action
• Preemptively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status reports
• Present file materials for authority and roundtables
• Work with nurses, doctors, and attorneys on file reviews
• Comply with all statutory and regulatory requirements of all applicable jurisdiction
• Meet detailed quality assurance standards and meet set goals for performance
• Set and revise case reserves in accordance with the reserving policy
• Identify potentially suspicious claims and refer to SIU; identify opportunities for third-party subrogation
• Be accountable for the security of the financial processing of claims, as well as security information contained in claims files
• Work with, and provide claim-specific guidance to, independent field adjusters
• Partner closely with internal teams and advise leadership of key claim activities and exposures

Preferred Qualifications

Advanced studies or insurance designation preferred

Benefits

• Partially subsidized medical plan
• Fully subsidized vision/dental options
• Life insurance
• Disability insurance
• 401(k)
• Flexible paid time off
• Parental leave