Claims Examiner II, Professional Lines

Tokio Marine HCC•Purchase, NY

3d•$74,500 - $102,300•Hybrid

About The Position

Under general supervision, investigates and analyzes coverage for pre-litigation claims submitted under the applicable employment practices liability or other professional liability policy form. Discusses claim facts and coverage issues with insureds, defense counsel, and/or coverage counsel. Possesses critical thinking and strong oral/written communication skills.

Requirements

High school diploma or the equivalent
Minimum of two years of relevant and progressive professional experience as a Claims Examiner
Possess and have ability to apply knowledge of principles, practices, and procedures
Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment
Experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
Time management skills.

Nice To Haves

4-year bachelor’s degree preferred

Responsibilities

Review submitted claims for coverage and determine if a matter is covered under the applicable policy.
Investigate claims and coverage issues.
Complete accurate and timely coverage investigations.
Draft actions plans, including coverage recommendations, for the approval of Claims Managers for claims.
Independently handle claims presenting moderately complex coverage issues.
Establish and revise claim reserves within designated authority based on claim developments and counsel liability assessments.
Draft timely coverage determination letters, including reservation of rights and denial letters.
Appoint defense and/or coverage counsel, as appropriate.
Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.
Update claims diary as needed based on activity.
Authorize settlements based on liability and other considerations within designated authority.
Review, approve, and process payment for legal, expert/vendor invoices, and settlement.
Conduct detailed bill reviews to ensure appropriate payment.
Maintain a claim file by accurately documenting all communications, activity, etc.
Communicate with agents, brokers and policyholders to obtain information necessary for processing claims.
Attend mediations, arbitration, etc. as needed.
Obtain and maintain claims adjuster’s licenses or other professional designations as required by the Company.