Sr. Claims Examiner I
The Senior Claims Examiner II is the highest technical position in the Claims Department, responsible for handling the most serious exposure casualty claims, including a high percentage of litigated claims, with complex coverage issues, complicated factual situations and/or significant injuries and damages. The Senior Claims Examiner II will handle a caseload in accordance with his/her experience and expertise without the need for close supervision.
Position & Responsibilities:
- In accordance with Company policies and in support of the Claims Department’s mission, the Claims Examiner II has the responsibility to ensure outstanding claims service.
- Promptly investigates each claim in accordance with the claims Department Best Practices.
- Initiates contact with insureds, claimants, witnesses, attorneys and other appropriate parties.
- Sets schedule for investigation, including determination of appropriate witnesses and parties to contact
- Reviews and evaluates policy coverage provisions, business classifications and underwriting guidelines.
- Makes recommendations regarding the handling of coverage issues.
- Composes reservation of rights letters, non-waiver agreements and coverage declination letters.
- May direct counsel on approved declaratory judgment actions.
- Oversees and controls investigation assignments made to independent adjusters and other vendors.
- Uses independent judgment to review and audits all vendor invoices.
- Sets initial reserves and ensures proper reserve evaluations throughout the life of a claim.
- Maintains an organized claim file, including appropriate file documentation.
- Maintains an effective and timely diary in accordance with Best Practices.
- Works with counsel to ensure they are in compliance with the Department’s Litigation Management Plan and Billing Guidelines.
- Uses judgment and discretion to equitably investigate, negotiate reserves and resolve all claims within the prescribed authority level, authorized by Senior Management.
- Recognizes and pursues potential opportunities using experienced judgment for recovery including subrogation, indemnification and/or contribution.
- Recognizes and refers potential suspicious claims or claims activity, based on experienced judgement, to the SIU in accordance with the Claims Department Best Practices.
- Establishes and maintains business relationships with Underwriting and reinsurers, as well as agents, insureds attorneys, vendors and other parties as appropriate.
- Provides timely and proper notification and updates to reinsurers.
- Participates in weekly roundtable meetings on claims issues.
- Completes special projects and performs other duties as assigned by the Claims Manager.
Requirements & Qualifications:
- Ten years minimum of technical experience required.
- Experienced claims professional who must possess a knowledge of coverage, statutory requirements and claims handling regulations.
- High degree of technical skill and expertise required to recognize and resolve technical claims issues and recommend and implement solutions within the granted authority.
- Requires excellent interpersonal skills and a high degree of initiative and decisiveness.
- Shows ability to use independent judgment and discretion in decision-making, including claims analysis.
- Ability to communicate with all levels of company management as well as the general public, attorneys and the company’s general agents in a professional manner.
- Must have strong analytical skills and knowledge of policy construction, and forms used by the Company.
- Must have strong computer skills with knowledge of Windows operating systems plus Word, Excel, PowerPoint and ImageRight.
- Must be able to effectively understand construction terminology, estimating systems, and building evaluations.
- Knowledge of the legal invoice review process (TyMetrix software) is a plus.
- Must possess or acquire adjuster licenses and complete CE requirements as needed.
- Must be able to travel on company business as needed.
- College degree or equivalent work experience required.
- Additional insurance related education/designation such as CPCU, AIC, AIM, SCLA, etc, preferred.
- Other advanced degrees are a plus.