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Effectively and clearly communicates coverage positions to brokers and policyholders. Reviews lawsuit documentation and supporting documents, claims file, investigation, etc. Establishes actions to be taken to resolve lawsuit. Includes determining loss coverage, amounts owed, discovery plans, setting reserves and negotiations. Participates in customer claim reviews as needed. Establishes appropriate working team (Home Office Legal, Defense Counsel and Home Office Claims) based on allegations established in suit. Responsible for managing the practices and billing activities of outside counsel. Accountable for security of financial processing of claims, as well as security information contained in claims files. Trains and mentors staff as appropriate; manages relationships and acts as liaison with various business partners (e.g., Workers Compensation Examiners, Underwriting, Service, Reinsurance, Etc.). Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to Employers Liability-related issues to Claims Management so appropriate action can be taken where required. Participates in special projects. Bachelor's degree and 5 to 7 years claims adjusting experience. Advanced knowledge of commercial casualty claims investigation, coverage evaluation, reserving & expense management, resolution strategy, negotiation, litigation management, claims evaluation as well as the insurance legal and regulatory environment. Intermediate to advanced level of skill in the area of customer focus, problem solving, communications, gaining support, teamwork, and adaptability and demonstrated ability to work independently, achieve results and execute thoroughly. Must be willing and able to travel as needed to attend activities related to litigation, team and customer meetings, and other, which may include overnight travel. 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Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels. Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation. Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports. Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports. Ensures adequacy of reserves. Recommends reserve increases on cases in excess of authority. Accountable for security of financial processing of claims, as well as security information contained in claims files. Updates files and provides comprehensive reports as required. Responsible for managing the practices and billing activities of outside and in-house counsel. Expected 10% travel for trials, mediations, and in-person events. 3+ years of Personal Lines Third Party Auto Casualty experience 3+years of Litigation experience Strong written and oral communications skills required. Strong interpersonal, analytical, negotiation and investigative skills required. Customer service experience preferred. Strong competency of legal liability, general insurance policy coverage and State Tort Law. The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 3 years of directly related experience. 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Required to obtain and maintain all applicable licenses. 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Set up claims and update the loss to reflect actual circumstances. Determine the need for independent adjusters or independent medical examiners. Evaluate claim for potential fraud. Assess actual damages associated with claims and conduct negotiations to settle claims. Be involved with litigated claims as necessary. High school diploma plus 1-3 years' of related customer service experience or applicable insurance knowledge. Licensing required in some states. Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. 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Determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company. Acts as senior technical professional on team, assisting team members with escalated issues. Mentors and trains new team members. Participates in Quality Review process. Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews. Performs other duties as assigned. BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). 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Manages, investigates, and resolves auto and homeowner's casualty claims. Investigates and evaluates coverage, liability, damages, negotiates and settles claims and manages litigation within prescribed procedures and authority. Provides analysis and recommends strategy and resolution plans on assigned cases in excess of their authority level to local claims management and Home Office. Identifies potentially suspicious claims and refers to SIU and identifies opportunities for third party subrogation. Prepares for and attends mediations, settlement conferences, trials and hearings and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports. Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advises as to proper course of action. Responds to various written and telephone inquiries, prepares status reports. Ensures adequacy of reserves. Recommends reserve changes on cases in excess of authority. Accountable for security of financial processing of claims, as well as security of information contained in claims files. Responsible for partnering with outside and in-house counsel on defense strategies. May assist in the absence of the Claims Manager, representing the company on matters involving state or federal regulatory agencies. May be involved in special projects and/or mentoring at the direction of local management. 5+ years of litigation experience Expert knowledge of handling personal lines complex claims with severe to catastrophic injuries and fatalities Must have an expert knowledge of coverage, liability, and complex claims handling procedures. Must be able to effectively handle claims at the highest technical and complexity level. Must be knowledgeable of state and federal laws in the adjuster's jurisdiction. A full working knowledge of claims operations and procedures is required. Excellent written and oral communications skills required as well as strong interpersonal, analytical, investigative and negotiation skills. The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 7 years of directly related experience. 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Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (injured workers, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly. Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources. Manages an inventory of worker's compensation claims, evaluates compensability/liability and losses, and negotiates settlements within prescribed limits. Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols. Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action. Responsible for review, analysis, and disposition of assigned claims within authority limits and state compliance. Updates file, strategizes and executes plans to mitigate exposure and increase disposal. Effective interpersonal, analytical and negotiation abilities required. Ability to provide information in a clear, concise manner with an appropriate level of detail. Demonstrated ability to build and maintain effective relationships. Demonstrated success in a professional environment; success in a customer service/retail environment preferred. Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent. Knowledge of legal liability, insurance coverage and medical terminology are helpful, but not mandatory. 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