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ERGO NEXT is a technology-led, full-stack provider of small business insurance, helping entrepreneurs thrive with fast, customized, and affordable coverage. Since 2016, the company has served hundreds of thousands of small business customers across the United States and is backed by industry leaders in insurance and tech.
As a Claims Specialist, you will be a subject matter expert in the Claims department, handling high-severity and high-complexity commercial claims. You will lead department roundtables and serve as a valuable peer resource to team members.
Key responsibilities include:
- Extensive policy document and legal contract interpretation
- Analyze and identify coverage issues using deep knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules, tort law, and claims best practices
- Manage, investigate, and resolve claims within prescribed authority levels
- Recommend ultimate resolution on assigned cases exceeding authority to claims management
- Leverage litigation handling experience in General Liability and Casualty files
- Drive litigation, attend mediations, trials, and alternative dispute resolution proceedings
- Communicate with policyholders, witnesses, and claimants to gather information and advise on proper course of action
- Respond to written and telephone inquiries with status reports
- Present file materials for authority and roundtables
- Collaborate with nurses, doctors, and attorneys on file reviews
- Comply with all statutory and regulatory requirements across applicable jurisdictions
- Meet quality assurance standards and performance goals
- Set and revise case reserves in accordance with reserving policy
- Identify suspicious claims and refer to SIU; identify third-party subrogation opportunities
- Ensure security of financial processing and claims file information
- Work with and provide guidance to independent field adjusters
- Partner with internal teams and advise leadership on key claim activities and exposures
Required qualifications:
- BS/BA degree
- 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
- Self-starter capable of working independently
- Must have or be able to promptly obtain a Texas Independent Adjuster License
- Proven success in delivering strong results in rapidly changing claims environments
- High comfort with ambiguous environments and willingness to assist coworkers
- Receptivity to feedback and continuous learning
- Up to 10% travel capability
Preferred: Advanced studies or insurance designation (e.g., AIC, CPCU).
