Sr. Claims Examiner I
The Senior Claims Examiner I is an advanced technical position in the Claims Department, responsible for handling serious exposure property claims, including litigated claims, with complex coverage issues, complicated factual situations and/or significant damages. The Senior Claims Examiner I will handle a caseload in accordance with his/her experience and expertise with some supervision.
Position & Responsibilities:
- In accordance with Company policies and in support of the Claims Department’s mission, the Senior Claims Examiner I has the responsibility to ensure outstanding claims service.
- Promptly investigates each claim in accordance with the claims Department Best Practices.
- Initiates contact with insureds, public adjusters, witnesses, attorneys and other appropriate parties.
- Reviews and evaluates policy coverage provisions and underwriting guidelines.
- Makes recommendations regarding the handling of coverage issues.
- Composes reservation of rights letters, non-waiver agreements and coverage declination letters.
- Directs counsel on EUO’s, appraisal process and approved declaratory judgment actions.
- Supervises and controls investigation assignments made to independent adjusters and other vendors.
- Reviews and audits all vendor invoices.
- Sets reserves within 60 days to see file to conclusion.
- Maintains an organized claim file.
- Prepares and maintains appropriate file documentation.
- Ensures all documentation is placed in the proper folder in the ImageRight file system.
- Maintains an effective and timely diary in accordance with Best Practices.
- Ensures compliance with the Department’s Litigation Management Plan and Billing Guidelines for all claims in which counsel has been engaged.
- Equitably resolves all claims within the authority granted.
- Recognizes and pursues potential opportunities for recovery including subrogation, indemnification and/or contribution
- Recognizes and refers potential suspicious claims or claims activity 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.
- Completes special projects and performs other duties as assigned by the Claims Manager.
Requirements & Qualifications:
- Eight years minimum of technical experience required.
- Must possess 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.
- 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.