Customer Service Representative
P&C Senior Claims Advocate
JOB TITLE: P&C Senior Claims Advocate DIVISION: Property & Casualty REPORTS TO: FLSA STATUS: Exempt PREPARED BY: Jill Roesler
Summary:
The Senior Claims Advocate serves as a strategic claims resource and trusted advisor to clients, providing expert guidance and advocacy throughout the claim’s lifecycle. This position is responsible for managing complex, high-impact, and sensitive claims while ensuring clients receive exceptional service, proactive communication, and effective resolution.
As a senior member of the agency's claim’s function, this individual exercises sound judgment and independent decision-making, provides escalation support, cultivates strategic relationships with clients and insurance carriers, and serves as a mentor and resource to colleagues. The Senior Claims Advocate champions the interests of clients while strengthening the agency's value proposition, supporting client retention, and contributing to the continued development and success of the claims function.
Essential Duties & Responsibilities:
Complex Claims Management & Client Advocacy
• Manage, coordination, and resolution of complex, high exposure, disputed, and sensitive claims. • Serve as a strategic advocate for clients, ensuring their interests are appropriately represented
throughout the claims process. • Evaluate coverage issues, claim denials, settlement disputes, delays, and other complex matters;
develop strategies and recommendations to support favorable outcomes. • Provide expert guidance regarding policy provisions, coverage interpretation, claim valuation, and
settlement considerations. • Proactively identify potential challenges and intervene when claims handling, communication, or
resolution does not meet client expectations. • Collaborate with clients, adjusters, carrier representatives, legal counsel, and other stakeholders to
facilitate timely and equitable claim resolution. • Exercise independent judgment in determining appropriate courses of action and advocating for client
interests. • Identify opportunities to improve claims outcomes, minimize disruption, and enhance the overall client
experience.
Escalation Authority & Issue Resolution
• Serve as a primary escalation resource for complex, contentious, or unresolved claims issues. • Initiate and facilitate escalations to carrier claims leadership, management, and other appropriate
decisionmakers when warranted.
Senior Claims Advocate. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change
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• Assess the urgency, severity, financial impact, and potential client implications of claims issues to determine appropriate escalation strategies.
• Challenge delays, inadequate investigations, coverage determinations, and settlement positions when circumstances warrant further review.
• Exercise sound judgment in determining when matters require involvement from agency leadership, legal counsel, or other specialized resources.
• Provide recommendations and guidance to account managers and other agency colleagues regarding claims concerns and resolution strategies.
• Maintain ownership of escalated matters through appropriate follow-up, communication, and resolution.
Strategic Client Relationship Management
• Develop and maintain trusted, strategic relationships with key clients and decisionmakers. • Serve as a senior claim advisor for complex accounts, providing proactive guidance and high-level
claims support. • Participate in strategic client meetings, stewardship reviews, claims reviews, and renewal discussions. • Communicate claims trends, significant loss developments, and potential coverage or risk
management concerns to clients and internal stakeholders. • Demonstrate the agency's value through proactive advocacy, technical expertise, responsiveness, and
strategic problem-solving. • Partner with account management and sales leadership to support client retention, relationship
development, and growth opportunities. • Identify opportunities to strengthen client relationships and enhance the agency's claims service
offering. • Serve as a subject matter expert and trusted resource within the agency's claims function. • Provide mentoring, coaching, and technical guidance to claims colleagues and other agency team
members. • Assist in establishing claims best practices, service standards, workflows, and escalation protocols. • Support the development and implementation of department processes that promote efficiency,
consistency, and accountability. • Share knowledge, insights, and lessons learned from complex claims to strengthen team capabilities. • Collaborate with leadership on department initiatives, strategic planning, and continuous
improvement. • Demonstrate leadership through professionalism, initiative, sound judgment, accountability, and a
commitment to excellence. • Help promote a culture of client advocacy, collaboration, and continuous learning.
Technical Expertise & Risk Management
• Maintain advanced knowledge of property and casualty insurance coverages, policy language, claims practices, and industry developments.
• Analyze claims data, loss runs, and trends to identify potential coverage gaps, exposures, and risk management opportunities.
• Provide strategic recommendations to clients regarding loss prevention, risk mitigation, and claims management practices.
• Assist clients in understanding the financial and operational impact of significant claims. • Maintain professional knowledge through continuing education, industry participation, and relevant
insurance designations.
Senior Claims Advocate. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change
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Operational Excellence & Accountability
• Maintain comprehensive and accurate documentation of claims activities, strategies, communications, and outcomes.
• Monitor significant and complex claims to ensure appropriate progress and timely resolution. • Prepare executive-level claims summaries, reports, and presentations for clients and agency
leadership. • Identify opportunities to improve claims workflows, reporting, service delivery, and overall operational
effectiveness. • Take ownership of client commitments and ensure consistent, proactive follow-through. • Contribute to measurable service standards and department performance objectives.
Qualifications:
• Minimum of 5 years of progressive insurance industry experience in claims management, claims advocacy, complex claims handling, or a related role.
• Extensive knowledge of property and casualty insurance coverages, policy provisions, claims practices, and settlement processes.
• Demonstrated experience managing complex, high exposure, disputed, or sensitive claims. • Proven ability to navigate carrier escalation processes and influence claims outcomes. • Strong negotiation, analytical, communication, and strategic problem-solving skills. • Demonstrated ability to exercise independent judgment and make sound decisions in complex
situations. • Experience building and maintaining strategic client and carrier relationships. • Proven leadership, mentoring, and collaboration skills. • Ability to manage competing priorities while maintaining a high level of service and accountability.
Preferred Qualifications
• Property and Casualty insurance license. • Advanced professional designations such as AIC, CPCU, ARM, or CIC. • Experience in an independent insurance agency or brokerage environment. • Experience with executive-level client reporting, claims reviews, and stewardship presentations. • Demonstrated success in developing claims processes, best practices, or department initiatives.
Core Competencies
• Strategic Client Advocacy: Proactively champion client interests and pursue appropriate, equitable claims outcomes.
• Complex Problem Solving: Navigate challenging claims with technical expertise, critical thinking, and sound judgment.
• Escalation & Influence: Effectively engage carrier leadership and other stakeholders to advance claims resolution.
• Mentorship: Strengthen team capabilities through knowledge-sharing, coaching, and professional example.
• Relationship Management: Build trust and credibility with key clients, carriers, and agency partners.
Senior Claims Advocate. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change
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• Accountability & Ownership: Take responsibility for complex matters, follow-through, and client commitments.
• Strategic Thinking: Recognize broader client, operational, and agency implications of claims issues. • Continuous Improvement: Advance the effectiveness, consistency, and quality of the agency's claims
function.
Physical Demands & Work Environment
This position primarily operates in a professional office environment and requires the ability to work at a computer for extended periods, communicate by telephone and email, participate in virtual and in-person meetings, and occasionally travel to client locations as needed. Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of the position.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Most contact with customers by phone, email or virtual meetings. Travel is required to attend company meetings, client meetings and for training.
- Complex Claims Management & Client Advocacy
- Escalation Authority & Issue Resolution
- Strategic Client Relationship Management
- Technical Expertise & Risk Management
- Operational Excellence & Accountability
- Preferred Qualifications
- Core Competencies
- Physical Demands & Work Environment