The Senior Claims Representative is responsible for independently managing a complex portfolio of commercial auto claims, including high-exposure physical damage, property damage, total loss, fuel spills, medical payments, cargo damage, and multi-party liability claims. This role exercises advanced judgment in coverage analysis, investigation strategy, and claims resolution, while ensuring compliance with jurisdictional requirements. The Senior Claims Representative serves as a subject-matter resource for peers, provides guidance on escalation matters, and maintains strong relationships with insureds, brokers, vendors, and internal stakeholders to drive timely, accurate, and customer-focused claim outcomes.
- Lead proactive and timely communication with insureds, claimants, brokers, and internal partners, ensuring clear and accurate explanation of claim findings, liability impacts, and resolution strategies.
- Serve as a primary escalation point for complex or sensitive customer issues, providing expert-level guidance and resolution.
- Oversee vendor performance, including appraisers, independent adjusters, and specialty experts, ensuring timely and high-quality deliverables.
- Perform advanced coverage evaluations by applying policy language, statutes, regulations, and case law to complex loss scenarios.
- Communicate coverage positions clearly and professionally to all stakeholders, including issuance of detailed coverage letters.
- Provide consultative support to junior adjusters on coverage questions and jurisdictional compliance.
- Ensure claim files reflect complete, accurate, and timely documentation supporting all decisions, estimates, and communications.
- Monitor and validate data quality and statutory reporting compliance across assigned files and provide corrective guidance when necessary.
- Independently establish and adjust loss and expense reserves on complex and potentially high-severity claims, supported by robust analysis and documentation.
- Identify significant reserve changes early and collaborate with leadership and actuarial teams on trends and emerging risk indicators.
- Mentor junior adjusters on accurate and defensible reserving practices.
- Lead and manage comprehensive investigations through strategic engagement with insureds, witnesses, experts, authorities, and medical providers.
- Conduct or direct recorded statements, scene investigations, and technical evaluations as needed.
- Evaluate and pursue subrogation, contribution, and recovery opportunities, including direct negotiation with carriers and adverse parties.
- Manage claim workflows with disciplined diary practices, ensuring adherence to company guidelines, regulatory timelines, and best-practice standards.
- Direct external vendors in the evaluation of damages, liability assessment, and exposure analysis for complex claims.
- Oversee and resolve total loss claims, including valuation disputes, diminished value considerations, salvage processes, and heavy equipment appraisals.
- Negotiate settlements on complex claims using advanced negotiation techniques and industry expertise.
- Serve as a resource for junior representatives, offering guidance on coverage, investigations, claim strategy, and customer communication.
- Provide informal coaching and contribute to training initiatives as requested.
- Support continuous improvement efforts and department initiatives to enhance claims quality and operational efficiency.
- May perform other functions as assigned.