Senior Claims/TPA Oversight Examiner

About you and the role

The Senior Claims Examiner is responsible for adjusting claims and/or providing TPA oversight of the various entities under management. The role requires the ability to deal with a wide range of losses including high value and complex claims. The examiner, with minimal oversight, will lead and direct junior examiners, TPAs, and vendors. The role is responsible for performance, development, and coaching to maximize performance.

What you will be doing

• To ensure that implications for stakeholders, particularly policyholders, are given appropriate consideration in our business approach to deliver fair customer outcomes
• The adjusting of Claims either via paper or electronic presentations as required for all Syndicates and/or Group Companies
• Investigate, evaluate, negotiate, and adjudicate claims within authority and in a manner that consistently meets or exceeds our Claims Policies and Procedures
• Aid with initial triage, onboarding reviews, and scheduling of roundtable discussions
• Provide coaching, feedback, and direction on claims
• Manage the Claim Status Report documentation process
• Ensure all data is concise and accurate in electronic claim systems
• Use electronic diary systems to manage all claims
• Utilize data including loss runs to manage claims
• Set appropriate and accurate case reserves in accordance with the company’s reserving philosophies
• Manage attorneys and negotiate and liaise with co-insurers
• Negotiate settlements as part of the market and proactively seek to identify and progress direct settlements solely for Enstar companies or to extend market settlements to other Enstar companies
• Report claim developments and account information to management and the Litigation Legal team as applicable
• Conduct contract interpretation, manage cedant relationships and legal representation
• Conduct inspections of records when required and negotiate equitable claim resolution
• Monitor and oversee external agreement parties against SLA’s and report any performance issues to Management
• Comply with Enstar claims handling authority levels
• Support and assist Outwards, Commutation and Complex Claims teams as required
• Carry out duties within our internal policies and procedures in accordance with applicable law, rules, regulation, good governance and Enstar’s shared values, including putting clients at the heart of our business
• Work with external customers to address questions, resolve problems, and maintain rapport
• Assist with the Reinsurance reporting process
• Maintain applicable adjuster licensing
• In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require
• Serve as the lead and primary point of contact for TPAs and vendors
• Recognized as a claims expert and specialist within the organization
• Resolve complex claims issues and disputes
• Provide analysis of claims data, metrics, and results from TPA performance to effectively manage a portfolio of claims. Ability to communicate points and conclusions to relevant parties in a matter that matches the given audience’s need to level of detail and communication preferences.
• Provide periodic reports to management
• Coordinate claim reviews and provide data summaries
• Drive the performance management process for TPAs by communicating expectations, monitoring and evaluating performance, providing feedback and facilitating development
• Maintain transparent communication by appropriately communicating organizational information to TPAs through meetings, emails and regular communications
• Manage corporate expenses by monitoring file allocations, resources and other expenditures to ensure appropriateness
• Ensure compliance with all legal, regulatory, and internal control requirements
• Provide claims insights to assist other business units by collaborating on data analysis and trends
• Maintain professional and technical knowledge by attending educational workshops, professional publications, establishing personal networks, and participating in professional societies

What you will bring

• Technical knowledge of Property & Casualty claims
• Significant experience (8+ years) in adjusting claims relevant to the classes of business handled
• Good knowledge of contract wordings, coverage, and reinsurance structures
• Detailed understanding of good faith claims handling
• Working knowledge of State specific Claims Handling Guidelines
• General understanding of legal principles as they pertain to insurance claims.
• Bachelor’s degree preferred
• Ability to serve as a resource, train, and mentor junior staff, based on being an expert within the organization
• Analytical skills
• Knowledge of insurance regulations and industry best practices
• Ability to work independently
• Excel proficiency
• Experience managing a Casualty and/or Professional Liability portfolio preferred
• Exposure to participation in due diligence reviews preferred
• Presentation skills
• Understanding of actuarial concepts

Your Benefits

• Enstar offers best-in-class Medical, Dental, and Vision healthcare for single and family coverage.
• Board-certified doctors and pediatricians are available virtually 24/7 for urgent care.
• Access to Health Savings Account (HSA) or Flexible Spending Account (FSA).
• Access to Dependent Care FSA to cover daycare expenses.
• Access to Employee Assistance Programs (EAP) for health and well-being.
• Optional Pet & Home/Auto Insurance.
• Wellness Reimbursement program (up to $600 annual reimbursement for wellness-related expenses, i.e., gym memberships, massage, etc.).
• 401K retirement plan (company matches up to 6% of employee contribution).
• One paid annual volunteer day.

General Info

The target base salary pay range for this role is $95,000-$135,000*

*Target full-time equivalent base salary range is based on relevant market data. The actual salary offered will depend on applicable market data for hiring location and relevant candidate knowledge, skills/experience. This salary range is not inclusive of applicable discretionary incentives.

Who we are

We are a trusted global re/insurance group and the leading provider of retrospective solutions, with specialist underwriting capabilities. We help our clients manage risk, unlock capital and create the financial freedom to grow. With operations across the world’s major insurance hubs and a global network of close to 800 talented professionals, we bring expertise and fresh thinking to some of the industry’s biggest challenges.

For more information about Enstar, visit our website

www.enstargroup.com.

For more information about careers at Enstar, visit our LinkedIn Life page or visit our careers site

Enstar Inclusivity Policy

We’re an equal opportunity employer and believe that our inclusive environment creates an authentic working culture. We don’t discriminate on the basis of age, physical or mental disability, gender reassignment, marriage and civil partnership, pregnancy and carer status, race (including colour, nationality, and ethnic or national origin), religion or belief, sex and sexual orientation. Enstar is committed in providing an accessible recruitment experience for all those interested in working with us. Please let your Enstar Recruitment Partner know if you require any reasonable accommodation during the application process due to a disability to enable you to fully participate in our recruitment process.

If you can't see a job that interests you, why not register for our job alerts by email service?

And we’ll email you when a job that matches what you're looking for is uploaded onto the site.