CLAIMS SPECIALIST SENIOR

Santiago de Chile Permanente

Publicado el 19/07/2022

  • Special focus in property, financial lines, and liability claims.
  • Analysis and resolution of complex insurance and reinsurance claims and coverage

Sobre nuestro cliente

recognized multinational General Insurance Company

Descripción



Responsibilities include but not limited to:

  • Daily handling, analysis and resolution of complex insurance and reinsurance claims and coverage issues.
  • Management of claim portfolio at all levels of the adjustment process, ensuring the correct reserving, technical analysis, settlement and payment of claims.
  • Registering appropriate claim reserves, monitoring them and keeping them duly updated in the system and reporting large claims as per LCR definitions and Everest Guidelines.
  • Keeping the system updated with relevant claims communications, supporting documents, Preliminary
  • Reports & FAR, payment and settlement/release documents.
  • Preparation of complex denial of coverage presentations and coverage position letters, Impugnation to Final Adjustment Reports (FAR) and Observations to Preliminary Reports of Article 24 of DS 1055.
  • Due drafting & handling of settlement/releases and revision of supporting payment documents, ensuring its proper signature as per policies, protocols and formalities defined.
  • Daily assistance to insureds, brokers, reinsurers & coinsurers on complex claims related matters and queries.
  • Monitoring adjustment actions and process, and legal adjustment terms as per SLA and applicable regulations, requesting further technical arguments and explanations when required and updated reports.
  • Investigating, analyzing, and evaluating liability and damages.
  • Evaluating, determining and Monitoring trial development handled by panel counsel.
  • Preparing case summary reports related to matters of significant reserve, involving new trends, trial activity, denial of coverage or contingencies, etc.
  • Coordinating and monitoring recovery actions and salvage process, keeping the system updated.
  • Working with underwriters to support policy construction and drafting, reporting policy contingencies, gaps, claim trends, data analysis, and risk assessments.
  • Evaluation and definition of defense strategy on liability claims, and monitoring of nominated counsel.
  • Strict compliance with claim monetary and non-monetary authorizations.
  • Strict compliance of Everest International Claims Standards and LCR, and all other internal guidelines.
  • Strict compliance with Everest Macro Claim Process for Chile and all related guidelines.
  • Collecting and monitoring payment from reinsurers and coinsurers & keep the system updated with actions & payment status
  • Monitoring and control of claim related costs & expenses.
  • Developing and executing claim strategies as well as resolution strategies.
  • Managing, directing and monitor outside counsel on claim related matters, such as coverage opinions, arbitrations, etc
  • Attending conferences and handling all necessary and relevant communications related to claims and complex matters with insureds, brokers, reinsurers & coinsurers, actuaries, underwriters, adjusters, experts, and other vendors.
  • Negotiating and resolving complex coverage issues as per claim authorities and guidelines.
  • Monitoring relevant jurisprudence on Civil and Labor Cases.
  • Attending meetings and conferences with brokers and/or insureds, and industry functions to support retention and development of client relationships and business.
  • Performing similar work-related duties as assigned.

Perfil buscado (Hombre / Mujer)

Qualifications, Education & Experience:

  • Professional title (preferably law, accountancy & engineer). If lawyer, due knowledge of litigation, arbitration, and trial process.
  • 7-8 years of claims handling experience.
  • Language: Advanced English, written and oral.
  • Strong analytical and organizational skills.
  • Excellent verbal and written communication skills.
  • Strong negotiation and investigation skills.
  • Strong ability to think strategically.
  • Strong ability to work under pressure.
  • Stron ability to adapt to changes.
  • Strong ability to work with a Team.
  • Strong ability to identify and use relevant data and metrics to best manage claims.
  • Collaborative mind-set and willingness to work with a team, and also people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency.
  • Strong ability and willingness to present any claims related matters to senior management and to others in other group settings.
  • Strong ability to influence others and resolve complex, disputed claims.
  • Deep knowledge of the insurance industry claims process, applicable regulations and regulatory environment.

Qué ofrecemos

Attractive total compensation package

Ingresar referencia para vacante
JN-072022-5684234

Resumen de empleo

Sector
Seguros
SubSector
Reclamos
Industria
Insurance
Ubicación
Santiago de Chile
Tipo de contrato
Permanente
Refencia de empleo
JN-072022-5684234