Senior Claim Benefit Specialist
CVS Health$38,480 - $88,048/year
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Insurance, InsurtechIndustries
Requirements
- 5+ years of construction defect claims management experience preferred
- College degree or equivalent claims management experience required
- 10+ years litigation management experience preferred
- Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed
- Proficient computer skills including Microsoft Outlook, Word and Excel
Responsibilities
- Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives
- Build and maintain productive relationships with internal and external customers, including clients, underwriting and service teams, and agents
- Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions
- Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager
- Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc
- Document activities in writing within claim files
- Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier
- Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts
- Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager
- Evaluate, set, or recommend reserves for each file they are handling
- Prepare written reports as dictated by company policy and procedures
- Handle claims within guidelines of the Fair Claims Practices 790.03
- Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling
- Discuss unique and complex files with Supervisor/Manager
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What experience is required for the Senior Claims Specialist role?
Candidates need 5+ years of construction defect claims management experience preferred, a college degree or equivalent claims management experience required, and 10+ years of litigation management.
What are the main responsibilities of a Senior Claims Specialist?
The role involves adjusting complex or high exposure construction defect claims, researching coverage, investigating losses, documenting files, exercising settlement authority, assigning defense counsel, setting reserves, and providing updates to stakeholders.
Is this a remote position or does it require office work?
This information is not specified in the job description.
What is the salary or compensation for this position?
This information is not specified in the job description.
What does the company culture emphasize for this role?
The role requires contributing to a collaborative environment by demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals, while building productive relationships with internal and external customers.
Integrated Specialty Coverages, LLC
Insurance program administration using data and AI
About Integrated Specialty Coverages, LLC
Integrated Specialty Coverages (ISC) uses data and technology to improve the insurance process for brokers and carriers by creating and managing tailored insurance programs. They enhance underwriting accuracy and customer experience through data analytics and artificial intelligence, allowing for quick pricing indications. ISC stands out by simplifying the submission process and providing flexible insurance solutions, such as their customizable Homeowners program. Their goal is to deliver the fastest and most efficient service possible in the insurance industry.
Town of Harrison, New YorkHeadquarters
2016Year Founded
VENTURE_UNKNOWNCompany Stage
Fintech, Financial ServicesIndustries
51-200Employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Mental Health Support
Health Savings Account/Flexible Spending Account
Unlimited Paid Time Off
Paid Vacation
Paid Sick Leave
Paid Holidays
Hybrid Work Options
401(k) Retirement Plan
401(k) Company Match
Professional Development Budget
Conference Attendance Budget
Wellness Program
Short-term Disability
Employee Discounts
Phone/Internet Stipend
Risks
Integration of acquisitions like Abacus may face cultural and operational challenges.
New Marine Division may initially experience operational inefficiencies.
ISCX platform development could face technical challenges or delays.
Differentiation
ISC uses AI to provide pricing indications in minutes, enhancing efficiency.
The company offers tailored insurance programs, including an exclusive Homeowners program.
ISC's ISCX platform centralizes access for brokers and wholesalers across all business lines.
Upsides
Growing demand for AI-driven underwriting boosts ISC's market position.
Expansion into marine insurance aligns with global trade growth opportunities.
Rising need for personalized insurance products benefits ISC's data analytics capabilities.
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