Claims Specialist

Next Insurance

. Serve as a subject matter expert in the Claims department .

Posted 9/22/2026full-timeRemote • Texas • United StatesSeniorLead💰 $100,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing high-severity commercial claims, interpreting insurance policies, and navigating complex legal environments. Proven ability to collaborate with cross-functional teams and maintain compliance with regulatory standards while delivering results in a dynamic claims landscape.

Highest-signal resume keywords

Commercial General Liability ExpertiseTexas Independent Adjuster LicenseClaims Management and InvestigationStrong Communication SkillsNegotiation and Persuasion Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisPolicy InterpretationLegal Contract ReviewCoverage Issue IdentificationLitigation ManagementCase Reserve SettingSubrogation IdentificationRegulatory ComplianceMulti-Jurisdictional Claims HandlingInsurance Codes Knowledge

Soft Skills

Interpersonal SkillsAnalytical SkillsInvestigative SkillsTeam OrientationAdaptability

Tools & Technologies

Claims Processing SoftwareProprietary Software SystemsOff-the-Shelf Software Systems

Certifications & Qualifications

BS/BA DegreeInsurance Designation (Preferred)Texas Independent Adjuster License (Required)

Industry Keywords

Claims DepartmentGeneral LiabilityCasualty FilesArbitration RulesTort LawQuality Assurance StandardsPerformance GoalsSuspicious Claims IdentificationAlternative Dispute ResolutionCross-Functional Collaboration

About the role

Key responsibilities & impact

Serve as a subject matter expert in the Claims department
Handle high-severity and high-complexity commercial claims
Interpret policy documents and legal contracts
Analyze and identify coverage and related coverage issues
Apply knowledge of insurance contracts, claims practices, insurance codes, civil codes, vehicle codes, arbitration rules, regulations, and tort law
Manage, investigate, and resolve claims within prescribed authority levels
Recommend resolutions for cases exceeding authority to claims management
Handle litigation involving General Liability and Casualty files
Drive litigation and attend mediations, trials, and alternative dispute resolution proceedings
Communicate with policyholders, witnesses, and claimants to gather claim information and advise on appropriate action
Respond to written and telephone inquiries, including status reports
Present file materials for authority reviews and roundtables
Work with nurses, doctors, attorneys, and independent field adjusters on file reviews and claim-specific guidance
Comply with statutory and regulatory requirements
Meet quality assurance standards and performance goals
Set and revise case reserves according to reserving policy
Identify suspicious claims and refer them to SIU
Identify third-party subrogation opportunities
Maintain security of financial claim processing and information in claims files
Partner with internal teams and advise leadership on claim activities and exposures

Requirements

What you’ll need

BS/BA Degree required
Advanced studies or insurance designation preferred
At least 10+ years of directly related experience with Commercial General Liability and Litigation
Strong written and oral communication skills
Strong interpersonal, analytical, investigative, and negotiation skills
In-depth knowledge of multi-jurisdictional claims handling issues
Willingness to utilize and adapt to evolving technologies within Claims operations
Ability to work independently and be a self-starter
Must have, or be able to promptly obtain, a Texas Independent Adjuster License
Effective communication, presentation, negotiation, and persuasion skills
Ability to collaborate with cross-functional teams
Proven success delivering strong results in a rapidly changing claims environment
Commitment to excellence, company policies, and regulatory compliance
Team orientation and ability to build strong working relationships
Comfort navigating ambiguous environments and assisting coworkers with workloads or organizational projects
Receptivity to feedback, continuous improvement, and learning proprietary and off-the-shelf software systems
Some travel capability, likely up to 10%

Benefits

Comp & perks

Annual performance-based incentive program
Partially subsidized medical plan
Fully subsidized vision and dental options
Life insurance
Disability insurance
401(k)
Flexible paid time off
Parental leave
Equal employment opportunities and diverse, inclusive, and respectful workplace