Ensure compliance with Everest TPA Claim Handling Protocols
Direct and report on focused claim reviews and file audits
Maintain active diary system
Actively manage and resolve claims when appropriate
Participate in settlement conferences and mediation as needed
Participate in meetings with policyholders and brokers as needed
Analyze claims metrics including reserve accuracy, productivity, prompt communication; and expense management
Develop and execute on action plans to address deficiencies identified within quality reviews
Conduct regular meetings with TPA adjusters and managers to discuss trends and claim handling strategy
Develop and maintain relationships with underwriting groups and brokers/agents. Work with business partners to address customer service issues

6-8 years of claims handling experience or related legal experience
Past supervision experience
B.A. or B.S. required
Strong analytical and organizational skills
Excellent verbal and written communication skills
Strong negotiation and investigation skills
Strong computer use skills across multiple claim system platforms
Ability to think strategically
Ability to influence others and resolve complex, disputed claims
In-depth knowledge of the litigation, arbitration, and trial process
Currently holds or readily can obtain all required adjuster licenses
Ability to identify and use relevant data and metrics to best manage claims
Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency
Ability and willingness to present to senior management and to others in other group settings
Ability to compose summary reports of quality review findings
Ability to obtain vendor compliance to Everest claim department standards
Knowledge of the insurance industry, claims process and legal and regulatory environment

Senior Casualty Claims Specialist – TPA Oversight

Key skills