Claims Examiner I

Responsibilities

• Efficiently and effectively handle primarily basic third-party general liability losses in a “paperless” environment.
• Primary job function includes setting up new loss assignments in a timely manner in compliance with Department guidelines and best practices.
• Establishes appropriate initial loss and expense reserves and regularly evaluates the file for adequacy, accuracy, and adherence to reserving guidelines.
• Analyzes and interprets policy language in conjunction with specific loss facts to reach appropriate coverage decisions.
• Drafts frequent coverage correspondence, including reservation of rights and coverage disclaimers in compliance with various state statutes and regulations.
• Composes a variety of other detailed correspondence to insureds, claimants, attorneys, agents, and Regulatory agencies.
• Proactively manages claim files from inception to closure, including identification and investigation of coverage, liability, and damage issues, determination and efficient execution of an appropriate plan of action, and prompt, economical file resolution, in compliance with Department guidelines and best practices.
• Consistently demonstrates coverage analysis, investigation, evaluation, and negotiation skills at a basic and frequently higher level.
• Directs and controls the activities and costs of numerous outside vendors including independent adjusters, defense counsel, and coverage counsel.
• Effectively presents and discusses loss facts and issues in roundtable discussions to peers and members of management.
• Composes and transmits in a regular and timely basis Large Loss Reports and other detailed reporting documents as appropriate.
• Manages and monitors file caseload through the use of various resources.
• Obtains all required state adjuster licenses and maintains them as required via compliance with mandatory continuing education requirements.
• Initiates appropriate communication with members of management and other Departments.
• Attends internal and external seminars and other training events and provides feedback to peers and/or members of management.

Qualifications

• Must have at least five (5) years of insurance experience.
• Certificates as required by states.
• Must have intermediate knowledge of computer programs in a Windows environment, including Word, Excel, and E-mail.
• Education Requirement: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
• Some college preferred.
• CPCU, AIC, AEI or completion of other insurance-related classes is preferred.