Casualty Examiner (Hybrid)

NYCM Insurance•Edmeston, NY

11h•Hybrid

About The Position

The Casualty Examiner manages first and third-party claims where potential exposure to bodily injury and property damage claims have been identified. This role requires a comprehensive understanding of insurance principles, claims procedures, and applicable laws. The examiner will be responsible for investigating claims, assessing reserves, negotiating resolutions, and collaborating with legal counsel and internal teams. Additionally, the role involves continuous learning and sharing of knowledge within the casualty team.

Requirements

High School Diploma
1 year in a business related field
Full working knowledge and understanding of basic insurance principals, claims procedures and applicable laws and regulations.
Basic knowledge of negligence, proximate cause, causality and impact on reserving and resolution of claims.
Understand anatomy, structures, and functions of the human body to analyze the relevant medical reports to complete an injury assessment.
Understand the importance of the claim experience to customers, and the fiduciary responsibility NYCM has to the customer on every claim.
Proficient personal computer skills including electronic mail, record keeping, routine database activity, Microsoft Word, PowerPoint, and Excel.
Excellent and effective oral and written communication skills.
Effective time management skills.
Detail oriented.
Strong decision-making skills.
Strong negotiation skills.
Ability to work both independently and within a team with minimal direct supervision.
Organized; Ability to multi-task and prioritize.
Ability to handle stress professionally, calmly, and effectively.
Positive and professional attitude with ability to influence and support change.

Responsibilities

Interpret coverages, policy terms and conditions for broad insurance areas and products.
Investigate coverage, liability, and damages.
Oversee aggregate reserves over one hundred million dollars.
Assess, manage, and monitor appropriate reserves.
Review and interpret medical records, legal documents, and all other documents associated with a casualty claim.
Analyze strengths and weakness of a casualty claim.
Negotiate fair and equitable resolutions.
Participate and contribute to daily casualty team committee reviews.
Collaborate with house and panel counsel members.
Collaborate with team to identify and ensure timely reporting of potential bad faith matters, claims that may fall under the purview of errors and omissions and those that may need to be reported to reinsurance.
Testify in litigation cases against NYCM to substantiate the reasoning behind conclusions made by them and/or direct reports.
Identify possible fraud and refer cases to SIU for collaboration.
Communicate and document clearly, concisely, and consistently in all casualty files and databases.
Adjust Reserves.
Continue education, claim knowledge, and claim concepts through interactions with supervisor, counsel, white papers, articles, books, and seminars pertinent to claim handling processes and techniques.
Share knowledge in collaboration with casualty team.
Other duties as assigned.