Claims Manager (Commercial Auto Litigation)

Claims Manager (Commercial Auto Litigation)

The James Allen Companies Inc
Published
April 9, 2019
Location
Richmond, VA
Category
Claims  
Job Type

Description

The Claims Manager guides and directs the operations of the Claims Team in conducting the investigation, evaluation and disposition of claims and suits brought against Insureds. The Claims team supports the Commercial Automobile Underwriting Division. Reporting to the Claims Manager include Claims Examiners, Senior Claims Examiners, Claims Specialists, and Senior Claims Specialists each of whom handles litigated or high priority claims or suits within the Commercial Automobile business segment. The Claims Manager may also have a Claims Assistant Manager who reports to them. The Claims Manager functions with autonomy to conduct team meetings, monitor caseloads, extend reserve and settlement authority and authorize referrals to both defense counsel coverage counsel when needed. The Claims Manager facilitates the setting of goals and objectives with direct reports, measures results and conducts annual performance reviews. The Claims Manager reviews and delivers regular Claims Quality Reviews and audits conducted by the Quality Assurance team. The Claims Manager conducts various additional file audits on their own and delivers the appropriate feedback of those audits to their individual direct reports. Claims Managers may be responsible for chairing or co-chairing committee claim review meetings, coordinating vendor programs or internal special programs including, but not limited to: IT projects, ISO and Medicare reporting, legal bill auditing, SIU, and policy form development.

Job functions:
Provides guidance and direction for all of the following activities: Analysis of coverage issues and taking appropriate action; Analysis of the facts and allegations to determine the extent of liability; Evaluation of causation and damages to determine potential exposure; Setting appropriate reserves to reflect probable outcome; Taking appropriate action to move the case toward resolution through alternative means, i.e., mediation, arbitration, trial, settlement. The Claims Manager uses excellent oral and written communication skills to interact with the Claims Team, brokers, claimants, attorneys and insureds regarding developments in the claim or suit. The Claims Manager ensures that all state regulations and internal guidelines are met by the team, and that each member of the Team manages claims and suits in accordance with company Best Practices. The Claims Manager functions with autonomy and is a key resource person on claims for the Commercial Automobile accounts they support.

Duties and Responsibilities
• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Supervises claim files handled by direct reports
• Reviews disclaimers and reservation of rights letters written by direct reports
• Delegate’s responsibility to refer cases to defense and coverage attorneys
• Provides guidance and direction to direct reports for coverage, liability and damage analysis, reserves, alternative dispute resolution and appraisal
• Oversees management of litigated and high priority files
• Maintains a high level of communication with leadership
• Works within authority limits and makes recommendations if higher authority is needed
• Reviews and sends correspondence and completes actions to satisfy department of insurance and/or state specific regulations
• Ensures that all state regulations and internal guidelines are met by the team and that each team member manages claims and suits in accordance with Claims Best Practices
• Assists the team in identifying special investigation fraud indicators and helps to refer those files accordingly
• Recognized as the key company claims contact within specialty area
• Provides technical guidance, assistance and training as needed for claims staff and other departments
• Assists the Director of Claims and/or VP in managing the Claims Department
Knowledge, Skills and Abilities
• Thorough knowledge of claims, strong leadership skills, recognized ability to manage a team of Claims Professionals
• Excellent written and oral communication skills
• Strong analytical skills
• Strong negotiation skills
• Self motivated, ability to motivate others, ability to delegate authority
• Well organized and possessing proficient computer skills
• Able to work successfully in a team environment
• Able to lead, guide and direct a team and also take direction from Director and/or VP of Claims
• Superior knowledge and skills in a variety of claims specialty areas
• Excellent record of achievements that clearly set the individual apart from others

Experience and Education
• College degree preferred
• Advanced degrees or Law Degree helpful but not required
• Five to Seven years of litigated automobile claims handling experience required
• Experience in working with complex coverage issues required
• Multi-jurisdictional claims and litigation experience required
• Adjuster license and/or certifications preferred

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