Claims Specialist I

Title:

Claims Specialist I

Company:

Compañía de Seguros Generales Everest México

Job Category:

Claims

Job Description:

Everest, a member of Everest Re Group, Ltd., has an opportunity for a professional (i.e., engineer, accountant, attorney), to join our Claims team in Mexico. This individual will handle and analyze mainstream and complex general insurance claims of all varieties, with special focus in property, financial lines, and liability claims.

Responsibilities include but not limited to:

• Daily handling, analysis and resolution of claims notified to Everest. Specialized knowledge of property claims is preferable.
• Management of claim portfolio at all levels of the adjustment process, ensuring the correct reserving, technical analysis, settlement and payment of claims. 
• Monitoring reserve development of cases, and proper and timely update of reserves into the Claims System, ensuring appropriate reserves are registered at all times of the process.
• Keeping system updated with relevant claims communications, supporting documents, Preliminary Reports & FAR, payment and settlement/release documents.
• 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 claim related matters.
• 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 of claim monetary and non-monetary authorizations.
• Strict compliance of Everest International Claims Standards and LCR, and all other internal guidelines.
• Strict compliance of Everest Macro Claims Process for Mexico 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, adjusters, experts, reinsurers & coinsurers, actuaries, underwriters, and vendors.
• Negotiating and resolving complex coverage issues as per claim authorities and guidelines.
• Monitoring relevant jurisprudence on Civil and Labor Cases.
• Performing similar work-related duties as assigned.
• Strong excel skills.

Qualifications, Education & Experience:

• Professional title (preferably law, accountancy & engineer). If lawyer, due knowledge of litigation, arbitration, and trial process.
• 5 to 6 years of claims handling experience.
• Language: Advanced or Intermediate English, written and oral.
• Strong analytical and organizational skills.
• Excellent verbal and written communication skills.
• Strong negotiation and investigation skills.
• Ability to think strategically.
• Ability to work under pressure.
• Ability to adapt to changes.
• Ability to work with a Team.
• Ability to identify and use relevant data and metrics to best manage claims.
• Collaborative mind-set and willingness to work with a Team.
• Ability and willingness to present to claims management and other members of the Company claim related topics.
• Knowledge of the insurance industry claims process, applicable regulations, and regulatory environment.

As an effective team member, employees at Everest must champion the Everest Insurance Culture:

• Collaboration: Open and transparent communication with customers and colleagues.
• Thoughtful Assumption of Risk: Supporting the Everest goal of carefully writing profitable business by ensuring data quality, prompt and accurate feedback to Underwriters, and operational control throughout the enterprise.
• Execution: Delivering outstanding support to the organization through strong day-to-day business operations, effective project management, and careful oversight of vendors.
• Humility: Caring and respectful approach to service colleagues, customers, and the community.
• Leadership: By example, every day.

Type:

Regular

Time Type:

Full time

Primary Location:

Mexico City, Mexico

Additional Locations:

N/A