Apply on Employer Site

Next Insurance · 4 hours ago

Claims Specialist

United States

Full-time

Remote

Senior Level, Lead/Staff

$100K/yr - $130K/yr

15+ years exp

NEXT is a technology-led provider of small business insurance, dedicated to helping entrepreneurs thrive. As a Claims Specialist, you will leverage your expertise in commercial claims to manage and resolve high-severity claims while serving as a resource for team members.

Commercial InsuranceFinanceInsuranceInsurTechSmall and Medium Businesses

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

Qualification

Commercial General LiabilityLitigation handlingInsurance contracts knowledgeTexas Independent Adjuster LicenseClaims managementAnalytical skillsTeam orientationAdaptability to technologyCommunication skillsNegotiation skills

Required

BS/BA Degree required

At least 15+ 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