Professional Liability Claims Examiner III

Job Details:
Level: Experienced,

Job Location:

Dallas
- Irving, TX, Position Type:
Full Time, Education Level: High School Diploma or GED, Salary Range: $80000.00 - $95000.00

Salary/year,

Travel Percentage :
None,

Job Shift: Day, Job Category:
Admin
- Clerical,

POSITION SUMMARY:

Under the oversight of the Area Manager, the Claims Examiner III reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority and company guidelines. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation.

Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

• Review, process and conclude assigned claims including investigation and evaluation of professional liability claims.
• Review and interpret policies, coverage determination.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department with requested tasks or special projects.
• Other duties as assigned.

Position is remote/working from home.

EQUIPMENT OPERATED/USED:
Computer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING:
Appropriate office attire when on video or attending client meetings.

Qualifications:

Education/

Experience:

Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

• Technical knowledge of coverage, statutory regulations, and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
• Ability to interact with people at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

• Active Independent Adjuster New York State License

[see separate attachment for a copy of checklist of mental and physical requirements]

MENTAL AND PHYSICAL REQUIREMENTS

MENTAL EFFORT

Reasoning development:

Follow one- or two-step instructions, routine, repetitive task.

Carry out detail but uninvolved written or verbal instructions, deal with a few concrete variables.

Follow written, verbal, or diagrammatic instructions, several concrete variables.

X Solve practical problems; variety of variables with limited standardization; interpret instructions.

Logical or scientific thinking to solve problems; several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development:

Simple additional and subtraction; copying figures, counting, and recording.

Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination requires theoretical application.

b. Language development:

Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information…