Claims Specialist - Executive Claims Specialist - Coverage - Claims-Made at James River Management Company

Come grow with James River Insurance! James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs. At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of being recognized the past 5 years as one of The Top Workplaces USA.James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company. Job SummaryUnder minimal supervision, the Claims Specialist/Executive Claims Specialist manages a caseload of high complexity commercial insurance claims focused on Allied Health (assisted living and skilled nursing facilities). The Claims Specialist will review claims to analyze land determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty.Duties and ResponsibilitiesContinuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer ServicePerform coverage, liability, and damage analysis on all claims assignmentsInvestigate allegations, determine facts based on evidence and interviewsDraft disclaimers and reservation of rights letters when coverage issues ariseAssign limited investigations and appraisals to independent licensed professionalsManage a caseload of high complexity claims with delegated authorityManage litigated filesNegotiate settlements, mitigate losses, and control expensesParticipate in and attend mediations to facilitate settlementsMaintain accurate documentation in claim filesMaintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokersAct as a consultant providing technical expertise within specialty area to internal stakeholdersProvide technical guidance, assistance and training as needed for less experienced Claims professionalsMaintain a passing quality assurance score on all audits and QAsProvide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim statusEnsure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrityHandle claims in accordance with established James River Claims Best PracticesOther duties as required by managementKnowledge, Skills and AbilitiesExtensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)Expert level of expertise in claim handling and suit managementExpert knowledge of P&C insurance industryExpert ability to effectively assess riskProficiency in MS Office (Word, Excel, Outlook)Excellent written and verbal communication skillsAdvanced analytical and organizational skillsAdvanced negotiation skillsAbility to work independently and take initiativeAbility to exercise sound judgement in making critical decisionsResearch, analysis and problem-solving skillsAbility to work in a team environment and accept feedback from Claims managementAbility to build effective relationships with business partnersAbility to organize complex information and pay close attention to detailAbility to anticipate customer needs and take initiative to meet those needsAbility to train and provide technical guidance to less experienced Claims professionalsAbility to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafterExperience and EducationClaims SpecialistHigh school diploma requiredBachelor's Degree preferredAdvanced Degree or Juris Doctorate Degree preferredMinimum of seven years of experience handling primary and excess claims-made and occurrence liability policies and claims. Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skillsAdjuster license and/or certifications desired preferredExecutive Claims SpecialistHigh school diploma requiredBachelor's Degree preferredAdvanced Degree or Juris Doctorate Degree preferredMinimum of ten years of experience handling primary and excess claims-made and occurrence liability policies and claims.Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skillsExtensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)Project management and process implementation experience preferred #LI-KS1#LI-RemotePlease note that this position is not eligible for H-1B visa sponsorship. All applicants must be currently authorized to work in the United States on a full-time basis without the need for current or future H-1B sponsorship.