Claims Examiner II, Professional Lines

Hcc Service Company • Mount Kisco, NY

130d • $74,500 - $102,300 • Hybrid

About The Position

Claims Examiner II is responsible for investigating and analyzing coverage for pre-litigation claims submitted under the applicable employment practices liability or other professional liability policy form. The role involves discussing claim facts and coverage issues with insureds, defense counsel, and/or coverage counsel. The position requires critical thinking and strong oral/written communication skills.

Requirements

• High school diploma or the equivalent; 4-year bachelor's degree preferred.
• Minimum of two years of relevant and progressive professional experience as a Claims Examiner.
• 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.
• Experience using Microsoft Office package (Excel, Access, PowerPoint, Word).
• Time management skills.

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 action 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.

Benefits

• Competitive salary and employee benefit package.
• Strong learning culture.
• Growth perspectives.
• 6% 401K match.
• 20 days of PTO and 2 Floating Days.
• Paid parental leave.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree