Claims Examiner; General Liability

The Claims Examiner is responsible for liability claims in the areas of: investigation, evaluation, reserving, negotiation and resolution of the companies’ claims in multiple jurisdictions.

The position is required to follow established claims management standards and exercise solid judgment when solving business problems; using critical thinking and decision-making skills and judgment within their assigned authority levels. The Claims Examiner continually explores ways to apply claim’s best practices to business challenges.

• Timely and effectively investigate and evaluate claims while managing outside adjusters and legal counsel
• Clearly and succinctly document files and prepare reports in timely manner
• Directs settlement activity using investigative and problem-solving skills in direct negotiations
• Handle all assigned cases efficiently and cost-effectively through conclusion
• Analyze and recommend appropriate reserves; periodically reviewing and adjusting these reserves based on the assessment of probable liability, financial responsibility and exposure
• Thoroughly review, analyze and interpret coverage in accordance with applicable policies
• Level of authority and complexity of decision making established by departmental management team
• Create and manage positive working relationships with internal and external business partners

• Presents a positive and professional image of the companies
• Knowledge and commitment to company mission, vision and organizational values
• Ability to quickly assimilate and practically utilize new information
• Possess written and verbal communications skills required to review, understand, interpret and convey data including medical records and legal documents, and coverage interpretation
• Strong customer service skills including interacting with internal and external customers
• Team player; works effectively as part of a team

Required:

• High School Diploma
• Bachelor’s degree in Business Management, Insurance, or related field, preferred; or equivalent work experience
• 3+ years of progressive liability claims handling experience
• Experience with the following claims: public officials’ errors and omissions, employment practices, law enforcement, mold, terrorism, lead based paint, employee benefit, and auto, preferred
• Experience with litigated claims, preferred
• All lines property/casualty adjuster’s license
• Ability to analyze and interpret coverage at a level commensurate with complexity of assigned claims
• Skilled in evaluating coverage issues and preparing clear, concise, and legally defensible coverage correspondence that accurately communicates claim decisions and policy provisions.
• Prepare and communicate written status reports, for policyholders, management and business partners, including treaty and facultative reinsurers, agents and brokers
• Understands current relevant case law and statutory law in multiple jurisdictions
• Ability to implement compliance processes and procedures to ensure consistent, efficient and effective compliance with all federal, state, local and filed requirements
• Review invoices, estimates, and other documents to ensure accuracy and legitimacy prior to payment
• Knowledge of insurance operations
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Must be able to be on-site for two weeks for training upon hire in our Cheshire, CT office

Preferred:

• Auto claims handling experience
• Knows the Public and Affordable Housing business

• Inside climate-controlled office building
• Prolonged sitting and using a PC

Please note this job description is not designed to cover or contain a comprehensive listing of…