The Travelers Companies, Inc.
Complex Case Commercial General Liability Claim Representative
Posted on Jul 29 Walnut Creek, CA 99 views
Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Description Summary
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.
Travelers offers a hybrid work location model that is designed to support flexibility.
Primary Job Duties & Responsibilities
- Directly handles assigned severity claims.
- Provides quality customer service and ensures file quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
- Consults with Manager on use of Claim Coverage Counsel as needed.
- Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
- Complete outside investigation as needed per case specifics.
- Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
- Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
- Maintains claim files and documents claim file activities in accordance with established procedures.
- Utilizes evaluation documentation tools in accordance with department guidelines.
- Proactively reviews Claim File Analysis (CFA) for adherence to quality standards and trend analysis.
- Utilizes diary management system to ensure that all claims are handled timely.
- Establishes and maintains proper indemnity and expense reserves.
- Recommends appropriate cases for discussion at roundtable.
- Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
- Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
- Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance.
- Develops and employ creative resolution strategies.
- Responsible for prompt and proper disposition of all claims within delegated authority.
- Negotiates disposition of claims with insureds and claimants or their legal representatives.
- Recognizes and implements alternate means of resolution.
- Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
- Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy,
- Tracks and controls legal expenses to assure cost-effective resolution.
- Effectively and efficiently manages both allocated and unallocated loss adjustment expenses.
- Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
- Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
- Recognizes cases, based on severity/complexity protocols that should be transferred to another level of claim professional and refers on a timely basis.
- Appropriately deals with information that is considered personal and confidential.
- Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions and inquiries from agents and brokers.
- Represents the company as a technical resource, attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws.
- Actively provides mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
- Shares accountability with business partners to achieve and sustain quality results.
- Evaluates all claims for recovery potential; directly handles recovery efforts and/or engages and directs Company resources for recovery efforts.
- In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
- High School Degree or GED required with a minimum of 3 years bodily injury litigation claim handling experience.
Education, Work Experience, & Knowledge
- Bachelor's Degree preferred.
- 4 years bodily injury litigation claim handling experience preferred.
- Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills preferred.
- Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims preferred.
- Able to make independent decisions on most assigned cases without involvement of supervisor preferred.
- Thorough understanding of business line products, policy language, exclusions, ISO forms, and effective claims handling practices preferred.
Job Specific Technical Skills & Competencies
- Openness to the ideas and expertise of others actively solicits input and shares ideas.
- Strong customer service skills. - Intermediate
- Demonstrated coaching, influence and persuasion skills.- Intermediate
- Strong written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.- Intermediate
- Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. - Intermediate
- Attention to detail ensuring accuracy -Intermediate
- Job Specific Technical Competencies:
- Analytical Thinking - Intermediate
- Judgment/Decision Making - Intermediate
- Communication - Intermediate
- Negotiation -Advanced
- Insurance Contract
- Knowledge - Advanced
- Principles of Investigation - Advanced
- Value Determination - Advanced
- Settlement Techniques - Intermediate
- Legal Knowledge - Intermediate
- Medical Knowledge - Intermediate
Environmental / Work Schedules / Other
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.