COMPLEX CLAIMS UNIT MANAGER
The Complex Claims Unit Manager will oversee the administration of complex homeowners claims as identified by factors such as late reporting, multiple claims reported at the same time, referrals from daily claims units based on CRN’s received, appraisal demands received, significant coverage questions, red flags found during the claim investigation, EUO of insured or AoB vendor recommended by counsel handling the CRN and other factors that warrant the elevation of the claim to the complex unit. The Complex Claims Unit Manager is responsible for oversight of the claims managers and claim handlers to achieve timely and effective disposition of claims in accordance with the available coverage and applicable procedures, laws and regulations.
The successful candidate will have a minimum of ten years of experience handling 1st party property claims and a minimum of 5 years of management experience handling Florida homeowner property claims.
This is an in-office position located in the Frontline Lake Mary, Florida office.
- Reviews detail of claims under applicable policy for first-party property losses to determine insurance coverage, effective dates, policy limits and exclusions. Identifies, monitors and resolves coverage issues, with assigned adjuster. Reviews and assigns claims to the appropriate adjuster as determined by the details of the claim as reported or when file transfer request is received.
- Directs and controls the establishment of appropriate claim reserves to ensure that future claim costs are accurately assessed, and the company can determine its financial position.
- Directs and manages desk adjusters’ activities. Reviews examiners reports for accuracy and determines details of loss and coverage.
- Reviews the file with assigned adjuster inclusive of estimates of costs of repair, replacement or compensation. Reviews and approves reserves in accordance with Frontline guidelines. Compares loss claimed to policy coverage and refers claims to the director of claims if loss exceeds managers authority levels.
- Requests additional authority level from the director of claims on a per file basis as required to fairly settle the claim if over the manager’s authority.
- Directs and manages complex adjuster to appropriately continue the investigation utilizing all available technologies to further investigate, document and resolve losses and coverage issues that were unable to be resolved within the daily unit.
- Interfaces with company clients, carrier, adjusters, or covered parties. Communicates with agents regarding status of claim.
- Assists adjusters as needed for proper resolution of claim. Calculates settlement or payment and communicates with client, adjuster and customer. Authorizes payment or settlement of claims within provided guidelines or seeks authority from the carrier. Reviews, approves or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
- Resolves disputes regarding claims resolution. May reopen and re-evaluate claim, if necessary.
- Participates in litigation when applicable.
- Monitors performance, reviews open and closed claims to ensure claims have been properly handled and moved towards resolution in a timely manner.
- Acts as an expert resource to others in the claims department regarding coverage issues, reserves, exposure, settlement value, and strategy.
- Responsible for assisting with staffing of the claims department with qualified employees.
- Conducts performance reviews and administers disciplinary measures, when required.
- Provides training to and development of adjusters
- Submits monthly management reports and prepares special reports when requested.
- Participates in special projects or tasks as required.
- Responds to inquiries from various state entities
- Responds to inquiries from other departments regarding claim handling, processing and coverage issues.
- Assists in the conducting of audits of vendors, primary and independent adjusters.
SUPERVISORY RESPONSIBILITIESThis job has no supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Must also be able to deal with problems involving several concrete variables in standardized situations.
- Language Skills: Ability to read and interpret policies, correspondence and governmental regulations. Ability to write reports as well as business and technical correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
- Computer Skills: Must be proficient with programs such as Word, Excel, Outlook, Adobe and other programs used by the company such as Guidewire, Legacy, Xactimate and Xactanalysis.
- Mathematical Skills. Ability to calculate figures and amounts such as interest, proportions, percentages, area, circumference, and volume. Ability to apply basic algebra and geometry.
- Reasoning Ability. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
- Comfortable working independently with a high degree of proficiency and self-motivation
EDUCATION AND/OR EXPERIENCE
- College degree and/or equivalent insurance designations.
- At least 10 years of experience adjusting property claims and five years first-party property claim management e
- Florida 520/620 license is required.
- Ability to obtain AL, GA, NC and SC adjuster licenses and any other states Frontline does business in.
- Strong personal lines coverage interpretation and claim handling background is required.
- Must have residential construction knowledge and be proficient in Xactimate.
- AIC designation or equivalent is preferred.
- Possess a valid driver’s license.
Ability to read and comprehend detailed instructions, correspondence, and memos. Ability to professionally execute excellent verbal and written communications. Ability to effectively present information in one-on- one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
NOTE: This is not necessarily an exhaustive list of responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, Frontline Homeowners Insurance reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed when circumstances change.
We are a Drug Free Workplace and EOE.