Senior Claims Examiner (Commercial GL) - Remote or Hybrid

About the role

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV).

Responsibilities

• Investigate, evaluate, and determine settlement value or denial of liability for severe to major-level general liability claims within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy.
• Make recommendations to set reserves at an appropriate level for claims outside of authority level.
• Prepare comprehensive reports as required.
• Identify and communicate specific claim trends and account and/or policy issues to management.
• Manage the litigation process through the retention of counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment.
• Document and manage claims (i.e.: record statements, updated diaries, write reports) from inception through closure.
• Ensure appropriateness of all payments.
• Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers.
• Assist in training of new employees.
• Provide training and daily guidance to other examiners.
• May fill-in for supervisor if necessary.
• Attend meetings and educational seminars for professional development and to maintain required licenses.
• Cook up with vendor services such as contractors, emergency repair, cleaning services and various replacement services.
• Facilitate between claimants, clients, brokers, and attorneys in resolution of liability claims.
• Superior customer service skills.
• Participate and/or conduct department meetings.
• Present company abilities in new client meetings.
• Conduct quarterly file reviews with the client.

Requirements

• High School Diploma or equivalent (GED) required for all positions.
• AA/AS or BA/BS preferred but not required.
• Relies on extensive experience and judgment to plan and accomplish goals with a minimum 8-10 years of complex/major claims experience including proficiency in investigation and resolution of severe to major casualty and general liability claims.
• High exposure general liability experience required.
• Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX or FL.
• Additional State Adjuster License(s) may be required within 180 days.
• Maintain licenses and continuing education requirements in all states.
• Experience with property and casualty insurance policies, insurance tort laws, codes and procedures.
• Understanding of medical, legal terminology and liability concepts.
• Proficiency in investigation and resolution of severe to major-level casualty claims.
• Time Management and project management skills.
• Negotiation skills.
• Well-developed verbal and written communication skills with strong attention to detail.
• Excellent organizational skills and ability to multi-task.
• Proficient in Microsoft Office Suite.
• Ability to learn additional computer programs.
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution.
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results.
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.

Qualifications

• Maintains honesty and integrity.
• Complies with company policies and procedures.
• Adheres to confidentiality policies.
• Follows safety protocols.

Skills

• Advanced knowledge in the following areas: claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge.
• Functional knowledge of law and insurance regulations in various jurisdictions.
• Demonstrated advanced verbal and written communications skills.
• Demonstrated advanced analytical, decision making and negotiation skills.

Benefits

The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments.

We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more!

Pay

The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time.

Schedule

The Senior Claims Examiner is responsible for working Monday through Friday at 37.5 hours per week.