Claims Casualty Examiner

Utica First Insurance Company • Oriskany, NY

6d

About The Position

The Claims Casualty Examiner investigates, evaluates, negotiates, and resolves casualty claims in accordance with company policies, regulatory requirements, and industry best practices. Depending on level, the examiner may handle claims ranging from routine matters to complex, high-exposure, and litigated losses. The role works with policyholders, claimants, attorneys, agents, medical providers, vendors, and internal departments to achieve fair and timely claim resolution while delivering exceptional customer service. The position reports to the Claims Casualty Supervisor.

Requirements

• Knowledge of casualty insurance coverages, liability principles, and claims handling practices appropriate to the assigned level.
• Strong analytical, investigative, and problem-solving skills.
• Effective negotiation and conflict-resolution abilities.
• Excellent verbal and written communication skills.
• Strong organizational and time-management skills, including the ability to manage multiple priorities.
• Ability to interpret insurance policies, legal documents, medical records, and other claim-related materials.
• Proficiency with claims management systems and Microsoft Office applications.
• Ability to exercise sound judgment and make informed decisions.
• Strong customer service and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Examiner I: 0–2 years of insurance, claims, customer service, legal, or related experience; ability to obtain and maintain required licensing and company certifications.
• Examiner II: 3–5 years of casualty claims handling experience; skill in claims investigation, timely reserving, settlement negotiations, and diary management; litigation management experience.
• Examiner III: 5+ years of casualty claims handling experience, including complex and litigated claims; demonstrated expertise in liability analysis, reserve evaluation, negotiation, diary management, and litigation management.

Nice To Haves

• Bachelor's degree preferred in Business, Insurance, Risk Management, Criminal Justice, Communications, or a related field, depending on level.
• Examiner II: Progress toward professional insurance designations such as AIC or CPCU.
• Examiner III: Professional insurance designations such as AIC, CPCU, ARM, or SCLA.

Responsibilities

• Investigate casualty claims by gathering and analyzing statements, reports, records, and other relevant documentation.
• Review and interpret policy language to determine coverage.
• Evaluate injuries and property damages, establish and maintain appropriate reserves, and develop resolution strategies.
• Negotiate settlements with claimants and attorneys.
• Maintain accurate, timely, and complete claim documentation.
• Communicate with policyholders, claimants, agents, attorneys, medical providers, and other involved parties.
• Identify, investigate, and address potential fraud.
• Manage claims in compliance with company standards, state regulations, and industry best practices.
• Monitor claim inventories to ensure timely file progression and resolution.
• Participate in claim reviews, audits, training programs, and continuing education activities.
• Provide technical assistance and mentorship to less experienced examiners, as appropriate based on level.
• Assist with special projects, departmental initiatives, and catastrophe response efforts as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed