Claims Examiner II (PIP)

Athens Administrators • Parsippany, NJ

2d • Hybrid

About The Position

Athens Administrators has an immediate need for a full-time Claims Examiner II to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday through Friday at 37.5 hours per week. As an Inside Property and Casualty Claims Examiner II, this candidate will be responsible for the review, analysis, and process of moderate to severe no-fault auto liability claims with an opportunity to handle Commercial Property, Inland Marine, and General Liability claims. These claims are typically moderate exposure and may entail litigation and coverage issues. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests.

Requirements

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL
• Additional State Adjuster License(s) may be required within 180 days
• Maintain licenses and continuing education requirements in all states.
• Minimum of 5 years PIP claims handling experience
• Knowledge regarding the handling and resolutions of arbitrations relating to New York PIP
• Knowledge of laws and regulations regarding PIP in multiple jurisdictions. Primary jurisdictions would be NY, FL, and NJ
• Knowledge of tort law, civil procedure, and contract law
• Knowledge of auto insurance laws, codes, procedures, and liability concepts
• Negotiation skills
• Relies on extensive experience and judgment to plan and accomplish goals in a fast-paced environment
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly, accurately and for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
• Must be able to reliably commute to meetings and events as required by this position

Nice To Haves

• AA/AS or BA/BS preferred but not required
• NY PIP experience preferred

Responsibilities

• Advanced knowledge in the following areas: 1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills.
• Investigate, evaluate, and determine settlement value of moderate level PIP commercial auto claims
• Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level
• Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to management
• Manage the litigation process through the retention of counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment
• Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure.
• Ensure appropriateness of all payments
• Coordinate and work with a vendor service such as appraiser, independent adjusting firms, contractors, social media and private investigation and various other field service vendors
• Facilitate between claimants, clients, brokers, and attorneys in resolution of liability claims
• Exchange information with clients, claimants, insurance brokers, inspectors, producers, and account managers
• Attend meetings and educational seminars for professional development
• Maintain required licenses
• Conduct quarterly claim reviews with the client

Benefits

• We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more!
• Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED