Claims Examiner – Spinnaker

About the role

The Claims Examiner – Partner Programs is responsible for the timely and accurate review and approval of claims exceeding the TPA’s/Claim Administrator’s authority, in accordance with company guidelines, regulatory requirements, and best claim practices. This role analyzes coverage, authority requests for reserves and payment on claims through resolution, including communication with internal and external stakeholders.

Responsibilities

• Review claims submitted by TPAs and authorize reserves and payments where those amounts exceed the TPA’s authority
• Provide guidance to TPAs to ensure proper investigation and timely, equitable disposition of claims, including retention of experts and/or attorneys where needed
• Assist TPA with coverage analysis, seeking underwriting assistance where appropriate
• Review and approve reservation of rights and coverage denial letters to ensure accuracy and consistency in coverage analysis
• Review claims to ensure appropriate reserve levels and that changes are made on a timely basis
• Refer claims more than authority to supervisor
• Prepare notifications to underwriters and reinsurers for large or contentious claims
• Review and approve TPA funding requests within authority
• Participate in claim file audits to monitor TPA performance
• Assist with preparation of reports for underwriting, agents, insureds or state agencies as needed
• Provide clear and professional communication to TPAs/Claim Administrators, brokers, and program partners
• Issue timely claim correspondence, status updates, and regulatory notices
• Participate in claim reviews and provide updates to management as requested
• Escalate complex coverage or high-exposure matters to senior leadership
• Ensure claim handling complies with regulatory requirements and internal guidelines
• Maintain proper documentation in claim management systems
• Support data calls, audits, and reporting requests
• Assist with reinsurer reporting requirements when applicable
• Participate in training programs and technical development opportunities
• Seek feedback and coaching to continuously improve claim handling skills
• Contribute to team collaboration and knowledge sharing

Requirements

• 2–5 years of claims handling experience in property, casualty, or specialty lines
• Basic understanding of insurance coverage principles and policy interpretation
• Experience investigating and resolving claims, including exposure analysis and reserving
• Strong written and verbal communication skills
• Organizational skills with the ability to manage a caseload effectively
• Ability to work collaboratively with internal teams and external partners
• Proficiency in Microsoft Office applications (Excel, Word, Outlook)

Nice to Have

• Experience working with TPAs or program business
• Exposure to litigated claims
• Professional designations in progress or interest in pursuing (AIC, ARM, CPCU, etc.)

Benefits

• Multiple medical plans to choose from and 100% employer covered dental & vision plans for team members and their families
• 401(k)-retirement plan, short & long-term disability, employer-paid life insurance
• Flexible Spending Accounts (FSA) for health and dependent care
• Employee Assistance Program (EAP)
• Equity compensation
• Training and internal career growth opportunities
• Flexible Time Off
• 12 weeks of parental leave for primary and secondary caregivers
• Snacks and drinks available for onsite employees

Pay

The Morristown, NJ base pay range for this role is $85,000 – $120,000. Exact compensation may vary based on several job-related factors that are unique to each candidate, including but not limited to: skill set, experience, education/training, location, business needs and market demands.