Claims Examiner -Traditional


Responsibilities

Summary: 

Direct handling of moderate severity PD and BI claims and coverage and/or liability issue claims throughout the United States involving state specific laws and regulations.  Will work with the supervisory staff to conduct mentoring opportunities for the claims staff.

Main Responsibilities:

  • Investigate new claims, make liability decisions, apply comparative negligence where applicable and negotiate settlements.
  • Recognize coverage issues and work with supervisor to resolve.
  • Establish case reserves within company guidelines.
  • Refer law suits to properly approved defense attorneys and direct their handling, including authorization of discovery plans and expert retention.
  • Expense control of fees from independent adjusters, defense attorneys and other vendors.
  • Recognize the various state laws, regulations and claim handling compliance.
  • Document claim file notes clearly summarizing all correspondence and activities using factual and objective data.
  • Respond to time sensitive material including settlement demands, intercompany arbitration hearings and insurance department complaints.
  • Maintain a current diary on all open claims.
  • Respond to phone messages on the day they are received.
  • Attend mediations and trials as required.
  • Other duties as assigned by the claim supervisor.

Qualifications

  • Bachelor's degree (B.A.) from a four-year college or university with three years experience handling moderate to high severity bodily injury claims, preferably with 2 or more years experience in the public transportation or commercial liability field.
  • Working on an AIC or similar designation a plus.
  • Ability to read and interpret legal documents, insurance policies and medical reports and billings.
  • Ability to compose letters, emails, reports and comprehensive file notes.
  • Ability to verbally negotiate with claimants and attorneys.
  • Dual language ability a plus.
  • Working knowledge of Microsoft Word, Excel, PowerPoint, and Outlook.
  • Must be able to interpret policies, perform analytical research and investigations and make sound judgments from date and records collected.
  • Must have strong analytical and reasoning skills.
  • May involve work outside of normal hours to meet deadlines and/or personal performance objectives at employee's discretion.
  • Required to participate in after hours emergency phone rotation in one week increments 1 or 2 times a year.

Reports To: Claims Supervisor

Job Level: 7

Number of Openings: 2



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