Position Overview
The Claims Examiner is responsible for liability claims in the areas of: investigation, evaluation, reserving, negotiation and resolution of the companies’ claims in multiple jurisdictions. The position is required to follow established claims management standards and exercise solid judgment when solving business problems; using critical thinking and decision-making skills and judgment within their assigned authority levels. The Claims Examiner continually explores ways to apply claim’s best practices to business challenges.
Essential Functions
Timely and effectively investigate and evaluate claims while managing outside adjusters and legal counsel
Clearly and succinctly document files and prepare reports in timely manner
Directs settlement activity using investigative and problem-solving skills in direct negotiations
Handle all assigned cases efficiently and cost-effectively through conclusion
Analyze and recommend appropriate reserves; periodically reviewing and adjusting these reserves based on the assessment of probable liability, financial responsibility and exposure
Thoroughly review, analyze and interpret coverage in accordance with applicable policies
Level of authority and complexity of decision making established by departmental management team
Create and manage positive working relationships with internal and external business partners
Knowledge, Skills, Abilities
Presents a positive and professional image of the companies
Knowledge and commitment to company mission, vision and organizational values
Ability to quickly assimilate and practically utilize new information
Possess written and verbal communications skills required to review, understand, interpret and convey data including medical records and legal documents, and coverage interpretation
Strong customer service skills including interacting with internal and external customers
Team player; works effectively as part of a team
Job Requirements
Required:
High School Diploma
Bachelor’s degree in Business Management, Insurance, or related field, preferred; or equivalent work experience
3+ years of progressive liability claims handling experience
Experience with the following claims: public officials’ errors and omissions, employment practices, law enforcement, mold, terrorism, lead based paint, employee benefit, and auto, preferred
Experience with litigated claims, preferred
All lines property/casualty adjuster’s license
Ability to analyze and interpret coverage at a level commensurate with complexity of assigned claims
Skilled in evaluating coverage issues and preparing clear, concise, and legally defensible coverage correspondence that accurately communicates claim decisions and policy provisions.
Prepare and communicate written status reports, for policyholders, management and business partners, including treaty and facultative reinsurers, agents and brokers
Understands current relevant case law and statutory law in multiple jurisdictions
Ability to implement compliance processes and procedures to ensure consistent, efficient and effective compliance with all federal, state, local and filed requirements
Review invoices, estimates, and other documents to ensure accuracy and legitimacy prior to payment
Knowledge of insurance operations
Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
Must be able to be on-site for two weeks for training upon hire in our Cheshire, CT office
Preferred:
AIC designation
Auto claims handling experience
Knows the Public and Affordable Housing business
Work Environment and Physical Demands
Inside climate-controlled office building
Prolonged sitting and using a PC
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without…