Claims Examiner - Captive


Responsibilities

Summary:

Direct handling of bodily injury (BI) and property damage (PD) claims throughout the United States, involving state specific laws and regulations, with an emphasis on strong communication and customer service. 

Main Responsibilities:

  • Initiate the investigation of new claims, make liability decisions, and evaluate and negotiate settlements of assigned BI and/or PD losses, as appropriate.
  • Review each claim for proper coverage, bringing discrepancies to the supervisor's attention, and work to make coverage decisions.
  • Establish reserve setting in accordance with company policy.
  • Communicate settlements and reserve increases to insureds, as required by specific handling instructions.
  • Prepare and present occasional status reports and telephone conferences at the request of the insured.
  • Refer lawsuits to approved defense counsel, and manage their handling, including the authorization of experts, surveillance, etc.
  • Review and pay invoices of independent adjusters and other vendors in a timely manner.
  • Recognize state specific laws and claims regulations throughout the United States to insure that required state specific language is used correctly on releases and other claim documents.
  • Maintain compliance with claims practicing guidelines for specific claims states.
  • Document claim file notes clearly with all communications and activities that occur during the handling of the claim using factual and objective information.
  • Respond to time sensitive material, including but not limited to intercompany arbitration hearings and department of insurance complaints.
  • Maintain a 30-day diary on all open claims.
  • Obtain/maintain a non-resident adjuster license in various states.
  • Resolve assigned PD claims, and close those within 30 days, making sure evaluations and settlements are in compliance with state law.
  • Attend mediations, depositions, and trials, as required.
  • Other duties as assigned by the claim supervisor.

Qualifications

  • Bachelor's degree and a minimum of 3 years experience handling BI liability claims.
  • Commercial auto and multi-state experience helpful.
  • Claim designation a plus.
  • Ability to compose professional letters, e-mails, reports and comprehensive file notes.
  • Ability to speak effectively before vendors, customers, claimants, attorneys and company management.
  • Ability to establish a rapport and communicate with insureds regarding claim handling, liability decisions, reserves, and settlement ranges.
  • Must be able to communicate liability decisions and reserve increase decisions to the insured that has self-insured retentions.
  • Ability to write a comprehensive response to arbitrated claims.
  • Dual language ability a plus.
  • Working knowledge of Microsoft Word, Excel, Powerpoint and Outlook.
  • General knowledge of internet use, search functions, and research.
  • Must be able to interpret policies, perform analytical research, complete investigations, and make sound judgments from data and records collected in accordance with multiple negligence laws.
  • Ability to read and interpret legal documents, insurance policies, medical reports and billings.
  • Must have strong analytical and reasoning skills.

Reports To: Captive Claims Manager

Job Level: 7

Number of Openings: 1



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