Senior Claims Examiner I

What will you do?

• CLAIM INVESTIGATION: Investigate assigned claims reported under insurance contracts provided by affiliated Companies, including identification of information and documents needed to evaluate claims, assignment and direction of independent adjusters and review of public and other records and documents.
• Contact Insureds, Claimants and others by telephone and correspondence regarding information and documents necessary to evaluate and resolve claims, claim processes and related matters, and resolution alternatives.
• Comply with claims handling laws and regulations.

Coverage Analysis

• Identify, evaluate and, in consultation with management as necessary, analyze and determine respective rights and obligations of Company, Insured, Claimants and others under insurance contracts applicable to assigned claims.
• Coordinate with Legal Department on coverage, claims handling compliance, and other legal issues.

Loss Assessment

• Analyze, evaluate, and estimate liability of Insureds and loss of Claimants/Insureds for assigned claims and identify all potential losses to which Companies’ contracts of insurance apply.
• Identify and report potential fraud to Special Investigation Unit.

Claim Reserving and Settlement

• Establish and timely modify appropriate case reserve reflecting available information regarding assigned claims.
• Review and approve or disapprove invoices from independent adjusters and others for allocated loss adjustment expenses.
• Maintain and timely review diary of assigned claims.
• Negotiate and resolve assigned claims within established authority or submit authority request and recommend resolution to manager.

Communication and Documentation

• Prepare and maintain accurate and timely record of communications with Insureds, Claimants, and other third-parties;
• Review, establish and modify appropriate units reflecting potential loss exposures;
• Maintain appropriate Claim File including all required electronic and other records and provide information regarding assigned claims to manager and others as required.

Licensing

• Obtain and maintain all required licenses and certifications;
• Maintain current knowledge of insurance and claim management principles and practices through review of published opinions, trade periodicals and other professional literature and conferences.

Education and Experience

Bachelor's Degree in related field or equivalent work experience required.

One or more years work experience.

PREFERRED: Knowledge Interpretation and application of insurance contractsInsurance claim procedures, loss evaluation methods and claim resolution alternativesInsurance related courses such as AIC, CPCU

Skills and Abilities

• Investigation
• Evaluation and analysis
• Negotiation
• Case management
• Time management and prioritization
• Excellent oral and written communication, especially with individuals outside the Company
• Organize time and resources and handle multiple high priorities
• Research and evaluate alternatives, reach decisions, and make recommendations
• Maintain strict confidentiality
• Meet deadlines
• Work with detail with accuracy
• Work well with others