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About the Role

We are looking for a highly capable Complex Claim Specialist to join our team and work from our Omaha office. Alternatively, we can fill this position in our Albany, office. The position reports to a Claims Manager and is responsible for the investigation, evaluation, negotiation, and settlement of complex and high exposure auto bodily injury claims. This includes assessing coverage; contacting the insureds, claimants, and witnesses; engaging experts when needed to fully investigate the facts of the loss and to arrive at a proper conclusion in assessing liability and damages. The Complex Claim Specialist is ultimately responsible for liability and coverage decisions, damage assessments and the negotiation of a claim to conclusion. Handling UM/UIM exposures and reviewing litigation strategy and actions of defense counsel for claims involving Arbitration. Provide the insured with the promise of the policy and excellent customer service.

Responsibilities

Adjudicate complex and high exposure auto bodily injury claims, potentially with significant impact on departmental results.
Provide laser-focused customer service to our clients by providing superior claims outcomes and developing meaningful and long-lasting connections with our insured and brokers.
Analyze claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.
Address any excess policies that may be applicable to the loss.
Complete claim investigation, and/or review the initial investigation on reassigned files promptly and thoroughly to properly assess and evaluate the liability exposure and to ensure proper reserving for a given exposure in accordance with the company’s reserving philosophy.
Secure recorded statements from all parties; document file activity in a concise and comprehensive manner.
Adjudicate claims that have the greatest complexity and severity, with the highest exposure to the company and to the insured, which may include excess umbrella policies.
Manage diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Complete claim evaluations with settlement authority recommendations and present those recommendations to upper management.
Identify, assign, and coordinate the assignment and coordination of expertise resources to assist in case resolution.
Negotiate claims to a proper resolution within the authority extended.
Attend mediations if and when required.
Handle all fatality and pedestrian losses.
Proactively move files toward a proper resolution.
Establish and maintain an appropriate diary on all files.
Consult with defense counsel or medical experts if needed.
Apply cost containment methodology, when appropriate, claim review for medical necessity and reasonable and customary charges.
Utilize third party bill reviews when applicable.
Report to Underwriting when information is developed requiring a risk analysis of the policy.
Communicate with agents, providing updates, inquiries and alerts.
Adjudicate claims according to applicable state mandates/statutes; investigate, review and stay current on applicable case law.
Demonstrate responsibility in making liability assessments for first- and third-party losses, send required forms and state compliance documents/letters.
Obtain appropriate releases, court approved settlements for minors, or estate claims, structured settlements.
Attend pre-suit mediations.
Handle demands for Arbitrations and discovery associated with those claims.
Ensure compliance with state regulations and requirements.
Consider alternative dispute resolutions, utilizing creative resolutions when appropriate, to reach an effective resolution of a dispute.
Make daily decisions to determine the appropriate course of action for the file, considering the exposure of the insured, the company, cost, and risk factors.
Demonstrate an appreciation and passion for strong claim management.

Requirements

A specialized knowledge of adjudicating complex and high exposure auto bodily injury claims, including fatalities, as well as exceptional customer service focus.
A minimum of five years’ of experience adjudicating complex and high exposure auto bodily injury claims.
Two or more industry designations or four years of relevant experience in addition to those mentioned above can be substituted for a bachelor’s degree.
Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims within 120 Days.
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Farm Family and our customers’ ability to be profitable).
Ability to regularly exercise discretion and independent judgment with respect to matters of significance.
This role primarily faces problems and issues that are difficult and require an understanding of a broader set of issues.
A strong focus on execution in getting things done right.
Proven ability to consistently produce and deliver expected results to all stakeholders.
Finding a way to achieve success through adversity.
Being solution (not problem) focused.
Thinking with a global mindset first.
Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast-paced environment that is evolving constantly.
Must have excellent communication skills and the ability to build lasting relationships.
Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
Uses listening and questioning techniques to effectively gather information from insureds and witnesses.
Strong claim negotiation skills a must.
Knows how claims reserving techniques are used and how to assess whether a claim reserve is accurate.
Must possess a strong customer focus.
Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis.
Proficient in MS Office Suite and other business-related software.
Polished and professional written and verbal communication skills in order to present information accurately and effectively.
The ability to read and write English fluently is required.
Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.
Applicants must be legally authorized to work in the United States.
At this time, we are not able to sponsor or assume sponsorship of employment visas.

Skills

Complex claim adjudication
Auto bodily injury claims handling
UM/UIM exposure management
Litigation strategy review
Customer service
Negotiation
Claim evaluation
Expert resource coordination
Cost containment
Medical necessity review
Underwriting risk analysis
Communication
Time management
MS Office Suite proficiency
Business acumen
Independent judgment
Problem-solving
Adaptability
Resourcefulness
Intellectual curiosity
Listening and questioning techniques
Claim reserving techniques
Professional development

Location

In Office - Any employee, in any Clearbrook office, can apply for this opportunity and stay in their current location.
Omaha office
Albany office

Work Type

Full-Time
100% in-office

Experience Level

Minimum of five years’ of experience adjudicating complex and high exposure auto bodily injury claims.

Education Level

Bachelor's degree from an accredited university required.
Two or more industry designations or four years of relevant experience in addition to those mentioned above can be substituted for a bachelor’s degree.

Salary/Compensations

Albany Pay Range: $93,228 - $116,994

Benefits

Performance-based incentives
Comprehensive benefits program
Health insurance
Dental insurance
Vision insurance
401(k) with company match
Paid time off
Professional development opportunities

About the Company

Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage.
Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S.
The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.
At Clearbrook our Core Values are Integrity, Collaboration, Pursuit of Excellence and Forward Thinking. These values reflect who we are today and who we aspire to be - guiding how we work, how we lead and how we succeed.

Equal Opportunity

We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at 210-321-8400.