About this role
Description
Working under moderate direction, this role manages a book of specialty lines claims across the full claim lifecycle — from initial investigation through settlement and closure. The Claims Specialist conducts thorough investigations, recommends appropriate reserves, and resolves claims efficiently and cost-effectively within established authority limits for the line of business.
Responsibilities:
- Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition
- Documents claims and sets diaries for follow-up and key events using CMS
- Establishes appropriate indemnity and expense reserves within assigned settlement authority, reviewing regularly to ensure adequacy; recommends reserve levels for claims exceeding authority
- Prepares comprehensive claim reports as required
- Identifies emerging claim trends and account or policy issues, communicating findings to management and underwriting
- Manages the litigation process, including retaining counsel and overseeing case resolution
- Ensures adherence to line-of-business litigation guidelines, including budget management, bill review, and payment
- Actively participates in mediations and arbitrations within assigned settlement authority
- Participates in the claims audit process
- May support claims marketing efforts by engaging with brokers, risk managers, and reinsurers
- Maintains required insurance adjuster licenses
If the selected candidate lives within 50 miles of a GRS office, then the selected candidate must come into the office two days/month.
Qualifications
Qualifications:
- Bachelor's degree required; advanced degree preferred
- 5+ years of experience in claims handling, legal, or a related field
- Strong working knowledge of claims handling concepts, practices, and techniques, including coverage issues and product line expertise
- Solid understanding of insurance law and regulations across multiple jurisdictions
- Excellent verbal and written communication skills
- Strong negotiation skills, with the ability to resolve claims effectively within authority limits
Preferred Qualifications:
- Experience handling HMO and Provider Excess Claims
## Travel
10%