Claims Specialist

Job Summary- With moderate direction, handles single and multi-party personal or commercial line claims of low to moderate exposure and complexity within specific limits of authority by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.- Key Accountabilities- Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
- Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
- Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
- Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
- Assess damages by calculating applicable damages or range of damages allowed by law.
- Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
- Meet quality standards by following best practices.
- Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts.
- Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the insured.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
- Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
- Protect Zurichs reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks. And participating in professional societies.

Additional Job Functions- May manage litigation by assigning counsel within the approved panel where applicable; establishing litigation plan and budget; coordinating defense lawyer activities; continuously reviewing the potential for settlement with claimant; reviewing litigation expenses and authorizing payments.
- May be dedicated to handle claims for specific accounts to ensure consistency in service and enhance customer knowledge.
- Business Accountabilities-
- Anticipate, recognize and respond timely to inquiries regarding low to medium complexity and exposure commercial claims to contribute to customer satisfaction.
- Provide technical advice that enables a customer to solve a problem or improve business.
- Acquire and organize the relevant evidence and information to accurately assess the value of the claim.
- Collect data and document in establsihed system to facilitate decision-making.
- Adhere to local regulatory and governance requirements throughout the life of a claim to ensure decisions are made using the right standards.
- Assess and appoint claims vendors within agreed authority limits aligned to the organization´s Claims Vendor Management strategy.
- Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and continuous learning.
- Provide feedback on business processes and systems to identify opportunities for improvement.
- Performance Management Accountabilities- Model behaviors that demonstrate commitment to corporate values.
- Take accountability for participating in the performance management cycle.
- Participate fully as a team member and contribute to the improved performance of the team.
- Expand knowledge and exchange it with team members and business partners.
- Take action to manage own personal development.
- Education and Experience- Collaborate Together- Develop & Grow- Puts Customers First- Fuel Innovation- Technical Competency 1- Technical Competency 2- Motivational fit- Provide Clear Direction- Make it Happen- Education and Experience**Required**
- High school diploma/GED (high school equivalency) and 2 or more years of experience in related field.

**Preferred**
- Associate’s/Technical degree (or equivalent) OR Bachelors degree (or equivalent)

**Additional Education / Experience**
- Related experience may include experience in an office environment that required basic computer, analytical and organizational skills and the ability to multi-task.
- Ability to obtain and mai