Territory: This is a work-from-home, desk adjuster position. The preferred location/territory of the Associate who steps into this position is the Mountain Standard (MST) and/or Pacific Standard (PST) time zones.

This individual will handle large loss litigation claims for our private client members.

An ideal candidate will have:

• 2-5 years of large loss, and/or litigation claims experience.

• Commercial Casualty claims experience.

• First Party Medical (FPM) and/or Medicare claims experience.

• Demonstrated customer service expertise

• Ability to juggling multiple competing priorities simultaneously

(Internal use only) Compensation Band: F4

Job Description Summary

Are you poised and ready for an exciting opportunity to resolve unique and challenging insurance claims? Our Private Client team operates as a niche, stand-alone business, supported by the scale and resources of the entire Nationwide enterprise. If you have the maturity, confidence and resourcefulness to provide an outstanding level of service to sophisticated and savvy customers, we want to hear from you!

As a Claims Specialist, you'll work on claims that may include a combination of casualty, material damage and/or property for personal lines, including severe and complex bodily injury, extensive material damage and/or questionable liability. You'll be responsible for coverage investigation, liability evaluation, negotiation and settlement resolution. For claims that are in litigation, you'll direct defense counsel's handling of lawsuits. We'll count on you to promote and provide outstanding customer service.

Job Description

Key Responsibilities:

• Handles assigned claims promptly and effectively handles to conclusion with little to no direction and oversight. Claims may include complex and catastrophic casualty losses.

• Makes decisions within delegated authority, recommends settlement values in the disposition of serious and sometimes complex claims as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of excellent customer service.

• Investigates claims by obtaining medical reports, appraisals, estimates of property damage and evaluates bodily injury claims.

• Coordinates and reviews work performed by independent adjusters.

• Determines liability by obtaining data from interviews with persons associated with the case, recorded statements and police reports and documents the claim file.

• Pays claims accurately based on policy provisions, state mandates and/or fee schedules. Authorizes and/or approves all claim payments within granted authority, which may include litigation expense

• Prepares/reviews reservation of rights, non-waiver agreements and denials of coverage when appropriate.

• Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends special reserves where necessary.

• Maintains current knowledge of court decisions which may impact the claims function, current principles and practices, material damage techniques and repair technology innovations and policy changes and modifications.

• Maintains knowledge of other functions within assigned subject area. This may require attending various seminars or training sessions.

• Mentors less experienced claims associates and assists with training/presentations as assigned.

• Creates and analyzes severe incident reports, reinsurance reports and other information to home office, claims management and underwriting.

• Partners with Special Investigations Unit and Recovery to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial, or subrogation (property, material damage, casualty).

• Consults claims staff and defense counsel for discovery processes, lawsuit file/trial strategy as related to case-specific issues.

May perform other responsibilities as assigned.

Reporting Relationships: Reports to Claims Manager

Typical Skills and Experience:

Education: Undergraduate degree or equivalent experience preferred.

License/Certification/Designation: State licensing where required. Professional development such as IIA or CPCU preferred.

Experience: Five to eight years of claims handling experience, including experience with complex claims, all lines, personal and/or errors and omissions including bodily injury, extensive material damage and/or questionable liability. Position requires litigation experience.

Knowledge, Abilities, and Skills:

Knowledge: Proven knowledge of insurance theory and practices, insurance contracts and their application. Advanced knowledge of causality best claims practices, medical terminology and the legal aspects of court procedures affecting legal liability for all lines of insurance. Excellent customer focus and proven track record of proactively meeting customer needs.

Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Confirmed analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to establish repair requirements and cost estimates for extensive material damage losses and serves as a subject matter authority on respective claims projects. Organizational skills to effectively prioritize increased and more complex workloads. Demonstrates strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, repair persons, attorneys, agents and general public. Demonstrated leadership capabilities to effectively train, coach and provide feedback to less experienced associates. Confirmed ability to operate personal computer with proficient use of claims and business software.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Staffing exceptions to the above must be approved by the hiring manager’s leader and Human Resources Business Partner.

Values: Regularly and consistently demonstrates the Nationwide Values.

Job conditions:

Overtime Eligibility: Not Eligible (Exempt)

Working Conditions: Office environment. Must be available to work catastrophes (CAT) which may include working extended periods of time including holidays and weekends over the phone or in office environment. Field CAT duty is not required for this role.

ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.

Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.