Job Title: Claim Specialist
Department: Claims
FLSA Status: Exempt
Position Reports to: Claim Supervisor
Summary:
The Commercial Claim Specialist is a seasoned professional responsible for the end-to-end management of complex commercial insurance claims, with a focus on educational institutions. This role requires advanced knowledge of policy interpretation, investigative techniques, and strategic negotiation. The Specialist serves as a subject matter expert, providing guidance on best practices and ensuring claims are resolved efficiently, equitably, and in alignment with regulatory and organizational standards.
The Specialist will engage directly with school administrators, district representatives, and other stakeholders in academic environments, demonstrating sensitivity to their unique operational needs while maintaining a high standard of service and professionalism.
Essential Functions and Responsibilities:
- Advanced Claim Investigation & Evaluation
- Independently confirm coverage and conduct comprehensive investigations.
- Analyze complex claim scenarios, including multi-party liability and high-value losses.
- Collaborate with legal and technical experts to assess exposure and resolution strategies.
- Strategic Claim Management
- Lead the management of high-complexity claims, ensuring timely and accurate documentation.
- Utilize advanced claim systems and analytics to monitor trends and identify risk indicators.
- Mentor junior adjusters and contribute to continuous improvement initiatives.
- Expert Stakeholder Communication
- Serve as a primary liaison for high-profile or sensitive claims involving educational institutions.
- Deliver clear, empathetic, and strategic communication to insureds, agents, attorneys, and internal teams.
- Facilitate resolution meetings and provide expert-level updates to leadership.
- Coverage & Damage Assessment
- Interpret nuanced policy language and endorsements to determine coverage applicability.
- Conduct or oversee damage assessments using internal tools and external consultants.
- Provide recommendations for coverage enhancements or risk mitigation.
- Reserving, Negotiation & Settlement
- Establish and maintain reserves for complex claims with precision and foresight.
- Lead negotiations for settlements, balancing cost-effectiveness with fairness and compliance.
- Document all activities in accordance with regulatory and internal audit standards
Knowledge, Skills, and Abilities:
- Bachelor’s degree or advanced certifications (e.g., AIC, CPCU) preferred.
- Minimum 2-3 years of experience in commercial claims, with experience adjusting and claim resolution.
- Experience working with public school entities or educational institutions is strongly preferred.
- Knowledge of various state regulations as they apply to benefits administration and claim adjudication.
- Strong written and verbal communication skills.
- The ability to succeed and excel in a collaborative and team-based environment.
- Strong time management and desk management skills.
- Knowledge of and ability to operate efficiently in a Windows-based environment using Excel, Word, and Outlook as well as company claim administration software.
- Ability to work independently and to carry out assignments to completion.
- Growth potential beyond current role.
- Occasional travel required for field inspections, team meetings, or client visits.
Hours: Full-time, EST
Compensation: $75,000 – $110,000
Location: Cortland, NY / Long Island, NY or Remote within New York state