Senior Claims Examiner (Claims)

Job Summary

Under moderate supervision, the Claims Examiner manages a caseload of low to moderate complexity P&C insurance claims by reviewing claims to analyze and determine applicable coverage, facts, liability, damages, plan & strategy for resolution in accordance with state and company guidelines.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Perform coverage, liability, and damage analysis on all claims assignments
• May investigate allegations and determine facts based on evidence and recorded interviews
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to licensed insurance professionals
• Manage a caseload of low to moderate complexity claims with delegated authority
• Negotiate settlements, mitigate losses, and control expenses
• Assist in the management of litigated files
• Participate in and attend mediations to facilitate settlements
• Maintain accurate documentation in claim files
• Prepare correspondence to all required parties involved in a claim when necessary
• Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
• May assist in training existing and new Claims Associates
• Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
• Handle claims in accordance with established James River Claims Best Practices
• Other duties as required by management

Knowledge, Skills and Abilities

• Beginner level of expertise in claim handling and suit management
• Moderate knowledge of P&C insurance industry
• Ability to effectively assess risk
• Proficiency in MS Office (Word, Excel, Outlook)
• Excellent written and verbal communication skills
• Excellent organizational skills
• Ability to take direction from management
• Ability to work independently and take initiative
• Ability to exercise sound judgement in making critical decisions
• Research, analysis and problem-solving skills
• Strong negotiation skills
• Ability to build effective relationships with business partners
• Ability to perform effectively as part of a team
• Ability to organize complex information and pay close attention to detail
• Ability to anticipate customer needs and take initiative to meet those needs
• Ability to train and provide technical guidance to less experienced Claims professionals
• Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter

Experience and Education

Claims Examiner

• High school diploma required
• Bachelor's Degree preferred
• Minimum of one year of P&C claims handling experience including handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
• Adjuster license and/or certifications preferred

Senior Claims Examiner

• High school diploma required
• Bachelor's Degree preferred
• Minimum of three years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorney required
• Adjuster license and/or certifications preferred

Claims Specialist

• High school diploma required
• Bachelor's Degree preferred
• Advanced Degree or Juris Doctorate Degree preferred
• Minimum of seven years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
• Adjuster license and/or certifications desired preferred

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