The Role: The Complex Claims Specialist is a high-level examiner role that adjudicates assigned claims within given authority and provides operational support to the claims team. Responsibilities include: * Adjusts and resolves complex to severe claims that includes all phases of litigation * With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters * Reviews and analyses claim documentation and legal filings * Drives litigation best practices to lead defense strategy on litigated files * Mentors Claim Examiners and Associate Claim Examiners * Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions * Identifies emerging exposures and claims trends * Identifies suspected fraudulent claims and tracks with special investigations unit * Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities * Develops content and conducts training for claims team and underwriters as requested
