Claims Specialist I

hace 1 mes

Ciudad de México, Ciudad de México Everest, Consultoría, Administración y Back Office S de RL de CV A tiempo completo

Job Summary

We are seeking a highly skilled Claims Specialist I to join our team at Everest, Consultoría, Administración y Back Office S de RL de CV. The successful candidate will be responsible for handling and analyzing mainstream and complex general insurance claims of all varieties, with a special focus on property, financial lines, and liability claims.

Key Responsibilities

  • Handle and analyze claims notified to Everest, with a focus on property, financial lines, and liability claims.
  • Manage claim portfolios at all levels of the adjustment process, ensuring correct reserving, technical analysis, settlement, and payment of claims.
  • Monitor reserve development of cases and update reserves into the Claims System, ensuring appropriate reserves are registered at all times.
  • Keep the system updated with relevant claims communications, supporting documents, Preliminary Reports & FAR, payment, and settlement/release documents.
  • Draft and handle settlement/releases and revise supporting payment documents, ensuring proper signature as per policies, protocols, and formalities defined.
  • Assist insureds, brokers, reinsurers, and coinsurers on claim-related matters.
  • Monitor adjustment actions and process, and legal adjustment terms as per SLA and applicable regulations.
  • Investigate, analyze, and evaluate liability and damages.
  • Evaluate, determine, and monitor trial development handled by panel counsel.
  • Prepare case summary reports related to matters of significant reserve, involving new trends, trial activity, denial of coverage, or contingencies.
  • Coordinate and monitor recovery actions and salvage process, keeping the system updated.
  • Work with underwriters to support policy construction and drafting, reporting policy contingencies, gaps, claim trends, data analysis, and risk assessments.
  • Evaluate and define defense strategy on liability claims and monitor nominated counsel.
  • Comply with claim monetary and non-monetary authorizations.
  • Comply with Everest International Claims Standards and LCR, and all other internal guidelines.
  • Comply with Everest Macro Claims Process for Mexico and all related guidelines.
  • Collect and monitor payment from reinsurers and coinsurers and keep the system updated with actions and payment status.
  • Monitor and control claim-related costs and expenses.
  • Develop and execute claim strategies and resolution strategies.
  • Manage, direct, and monitor outside counsel on claim-related matters, such as coverage opinions, arbitrations, etc.
  • Attend conferences and handle all necessary and relevant communications related to claims and complex matters with insureds, brokers, adjusters, experts, reinsurers, coinsurers, actuaries, underwriters, and vendors.
  • Negotiate and resolve complex coverage issues as per claim authorities and guidelines.
  • Monitor relevant jurisprudence on Civil and Labor Cases.
  • Perform similar work-related duties as assigned.
  • Strong Excel skills.

Qualifications, Education & Experience

  • Professional title (preferably law, accountancy, and 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.

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.

Job Type

Regular

Time Type

Full-time

Primary Location

Mexico City, Mexico

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