Claim Examiner - Casualty
Responsible for the direct supervision of independent claim adjusters and vendors handling specified line(s) of business, i.e. auto, property or casualty. Certain designated Claim Examiners may be the primary file handler for specialized field based situations. The Claim Examiner may also have responsibility for support personnel. Primary responsibilities include handling and/or directing and monitoring the assigned claim adjusting and support personnel to ensure the timely, accurate and fair investigation, evaluation and disposition of all claims assigned. Employee should possess demonstrated expertise in handling complicated and significant bodily injury claims which involve comparative negligence theories and defenses, etc; and/or confidently capable of writing sizable detailed building estimates (including commercial) and handling complicated business interruption and pollution claims, etc. Employee should be highly skilled in all coverage’s written with an emphasis on the more difficult investigations, losses and exposures, and be capable of seeing more difficult adjustments through final resolution using a wide variety of settlement techniques. Claim outcomes must be consistent with policy terms and conditions, damages and legal requirements. Directly manage and oversee the assigned adjusting and support personnel and assure that they adhere to and comply with all Claim File Handling Guidelines and all other job expectations, statutes, regulations and requirements.
DUTIES & RESPONSIBILITIES
- Direct, handle and monitor assigned claims to produce results consistent with damages and legal requirements.
- The Claim Examiner may be responsible for the selection and oversight of independent adjusting firms and vendors
- Monitor and review the claim work product and perform periodic audits or re-inspections to ensure that productivity levels are met, and that desired quality expectations and standards are achieved.
- Review new losses and files on diary to ensure reserve adequacy, while providing appropriate file direction to the adjusting firms.
- Monitor loss adjustment expense and take steps to mitigate expenses wherever reasonably feasible.
- Assist coworkers and others interested with referrals to quality service providers as needed.
- Review coverage questions and provide direction, interpretation and approval.
- Refer appropriate coverage matters to Claim Supervisor or Manager.
- Ensure appropriate file handling, documentation and expense control of all assigned files.
- Provide accurate, courteous and timely information to all external and internal customers concerning claim status and other inquiries.
- Provide service calls to policyholders and agencies as needed.
- Serve as a technical resource within the Department through mentoring and knowledge sharing.
- Draft coverage correspondence, including reservation of rights and coverage disclaimer along with composing detailed correspondence to insureds, claimants, attorneys, etc.
- Attend trials, depositions, EUO’s, arbitrations and mediations where strategically advantageous or required by jurisdiction.
- Write and administer timely performance appraisals and recommend appropriate salary adjustments, if assigned support staff.
- Suggest improvements to processes within the department, or serve on committees, to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, systems upgrades, etc.
- Participate in setting file direction on complicated or high-exposure matters and recommend appropriate reserves on claim files within specific authority and on files requiring mandatory reporting to senior management.
- Confer with claims management, representatives, and other company personnel to plan, evaluate goals/objectives, resolve problems, and exchange information.
- Regulate referrals; produce reports analyzing performance levels and territory performance.
- Monitor and maintain diaries.
- Evaluate, procure, coordinate and deliver technical training to agents, adjusters and clerical personnel.
- Respond to customer, agency and Insurance Department complaints.
- This position is expected to directly handle certain claims entirely.
- Performs other duties or special projects as required or as assigned.
The Claim Manager or Claim Supervisor provides minimal direct supervision.
The Claim Examiner may provide minimal direct responsibility for support staff.
- Bachelor's degree in business, insurance or a related field, or its equivalent.
- Seven or more years of relevant claim supervisory and technical experience with demonstrated achievement and progressive responsibilities.
- Strong knowledge of the technical aspects of property and/or casualty claims (including automobile, general liability, subrogation and litigation).
- Knowledge of property/casualty insurance claims management processes, systems and regulatory requirements.
- Demonstrated commitment to professional development through continuing education related to the job through the attainment of recognized industry designations such as AIC, AEI or CPCU programs, etc.
- Appropriate state Adjuster’s License(s) where required by law.
- For field based positions, previous outside experience is preferred and valid driver’s license required.
- Fully developed skills in the technical aspects of property, auto or casualty claims, including extensive knowledge of relevant contract and tort law.
- Thorough understanding of the insurance industry and company operations.
- Highly developed analytical, and negotiation skills.
- Excellent verbal and written communication skills.
- Planning, administrative and supervisory experience.
- Demonstrated ability to exercise good judgment in dealing with professional and personnel matters.
- Demonstrated ability to work effectively with a wide array of outside firms and organizations.
- Demonstrated ability to deal effectively with company management, peers and co-workers.
- Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); Experience with imaging and estimating programs preferred.
- Ability to perform job responsibilities under stressful circumstances.
PHYSICAL DEMANDS/WORKING CONDITIONS
- Office positions are predominately sedentary with high frequency of keyboarding/computer work required.
- Field positions require regular outside day travel of approximately 50%.
- The physical demands are minimal and typical of similar jobs in comparable organizations.
- The work environment is representative and typical of similar jobs in comparable organizations.
- Occasional overnight travel.
- Potentially subject to adverse weather and stressful situations with respect to claim disputes.