Major Case Specialist

3 weeks ago

Oakville, Canada The Travelers Companies, Inc. Full time

Who Are We?

- Solid reputation, passionate people and endless opportunities. That’s Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.

- Job Category
Claim
Target Openings
1
What Is the Opportunity?
Investigate, evaluate, reserve, negotiate and resolve assigned serious and complex claims in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, and disposition. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.

What Will You Do?
- Directly handle assigned severe and/or complex claims.
- Consult with Manager on use of Claim Coverage Counsel as needed.
- Directly investigate 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 exposure.
- Interview witnesses and stakeholders, take necessary statements, as strategically appropriate.
- Complete outside investigation as needed per case specifics.
- Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants, fraud investigators, and other experts.
- Verify the nature and extent of injury by obtaining and reviewing appropriate records/documentation.
- Maintain claim files and document claim file activities in accordance with established procedures.
- Utilize evaluation documentation tools in accordance with department guidelines.
- Utilize diary management system to ensure that all claims are handled timely.
- At required time intervals, evaluate exposure.
- Establish and maintain proper indemnity & expense reserves.
- Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.
- Recommend appropriate cases for discussion at roundtable.
- Attend and or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
- Actively and enthusiastically share experience and deep knowledge of creative resolution techniques to improve the claim results of others.
- Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives. Recognize and implement alternate means of resolution.
- Manages litigated claims.
- Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.
- Track and control legal expenses to assure cost-effective resolution.
- Effectively and efficiently manage both allocated and unallocated loss adjustment expenses. Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.
- Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
- Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
- Recognize cases, based on severity/complexity protocols, that should be transferred to another level of claim professional and refer on a timely basis.
- Appropriately deal with information that is considered personal and confidential.
- Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquires from brokers.
- Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable Provincial laws.
- Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
- Share accountability with business partners to achieve and sustain quality results.
- Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.
- May be responsible to research and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and ma

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