Complex Claims Specialist-Professional & General Liability

Pharmacists Mutual Insurance Group has an opening for a professional and general liability Claims Specialist This position will investigate, evaluate, reserve, negotiate, and resolve assigned claims in accordance with Company guidelines. The Claims Specialist will provide timely, professional claim handling and superior customer service.

Claims Specialist - Professional and General Liability

• This position is responsible for handling complex litigated and non-litigated liability cases with the highest level of exposure.  This is a multi-line role and requires experience in professional liability, general liability and various other lines. The Specialist will provide oversight, consulting, training resources, and serve as a technical resource to the claims staff and other internal customers/partners.

Essential Functions

Essential functions may include, but are not limited to the following:

• Provides superior customer service and ensures file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Directly investigates each claim through prompt contact with appropriate internal and/or external resources and experts to determine the extent of liability, damages, and contribution potential. 
• Interviews witnesses and takes statements as necessary.
• Utilizes diary management system to ensure that all claims are handled timely and documents any rationale for departure from applicable protocols and methods.
• Attends and/or presents at roundtables/authority discussions for collaboration of technical expertise.
• Responsible for prompt and proper resolution/closure of all claims within delegated authority using developed creative resolution strategies or alternate means of resolution. 
• Negotiates disposition of claims with insureds and claimants or their legal representatives. 
• Tracks and controls legal and adjusting expenses to ensure cost-effective resolution.
• Attends mediations, arbitrations, pre-trials, trials and all other legal proceedings as needed.
• Manages files through the selection and direction of counsel in accordance with our litigation guidelines.
• Evaluates all claims for recovery potential; assists in recovery efforts and/or engages and directs Company resources for recovery efforts.
• Serves as a subject matter expert within the unit.
• Provides coaching and file oversight for others.
• Assists manager with quality control audits.

Knowledge, Skills and Abilities

• Understand principles and practices of insurance claims.
• Understand complex policy and contract coverage.
• Manage, negotiate and resolve claims.
• Ability and flexibility to work longer hours when workload fluctuations occur.
• Research and stay up-to-date with trends and changes in the claims/insurance industry.
• Communicate effectively with others (oral and written).
• Follow oral and written directions.
• Analyze complex issues and make critical decisions.
• Maintain records, prepare reports and correspondence related to the work.
• Demonstrate excellent writing skills, professional English usage, spelling, grammar, vocabulary and punctuation.
• Interpret and apply laws, rules and regulations.
• Determines when to escalate concerns to the appropriate level of management.
• Work effectively with others in a team environment.
• Establish and maintain effective working relationships with those contacted in the course of work.
• Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
• Excellent customer service skills.
• Ability to organize and prioritize work.
• Work independently and demonstrate drive and initiative.
• Ability to manage and resolve multiple high-exposure claims simultaneously.
• Ability to meet definite deadlines and deal with pressure situations.
• Collect, interpret, and input data efficiently and accurately.
• Use claims management related software efficiently and effectively.
• Use Microsoft Office programs efficiently and effectively.