Claims Examiner III Team Leader

Tristar Insurance•Philadelphia, PA

1d•$89,000 - $99,000•Remote

About The Position

Under the oversight of the Area Manager, the Claims Examiner III – Team Leader reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Auto Liability and PIP/No-Fault claims from inception through resolution, within established authority and company guidelines. In addition to maintaining an active caseload, the Team Leader provides day-to-day guidance and technical support to Claims Examiners, ensuring consistency, quality, and adherence to best practices. This role requires frequent interaction with clients, claimants, TRISTAR management, and internal staff. The Team Leader may also assist in mentoring and supporting Claims Examiners who report functionally to the role, while partnering with the Supervisor on escalations, training, and performance-related matters.

Requirements

Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.
Technical knowledge of coverage, statutory regulations, and medical terminology.
Strong Technical knowledge of NF/PIP Statutes in NY and NJ
Analytical skills.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
Ability to interact with persons at all levels in the business environment.
Ability to independently and effectively manage very complex claims.
Proficient in Word and Excel (preferred).
Active General Adjuster New York State License

Nice To Haves

Bachelor’s degree in related field
Proficient in Word and Excel

Responsibilities

Provides guidance, support and some supervisory directions to TRISTAR adjusters on the Tower/Venture Leasing Team whose duties are similar to those outlined above for claims they are assigned by the Claims Examiner III Team Leader
Help to establish procedures for American Arbitration Association to help reduce costs and improve process
Effectively manages a reduced caseload of approximately 50-75 Auto files, including large No Fault PIP exposure reportable claims
Investigates and conducts investigation in a timely manner for claims assigned.
Determines compensability of claims based upon state law and in accordance with established Company and client guidelines.
Communicate with clients, claimants, providers, and vendors regarding claims issues.
Computes and set reserves within Company guidelines. Authority Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
Approves authority requests of direct repots for claims assigned and directs them to obtain authority as designated
Settles and/or finalizes all claims assigned and obtains authority as designated.
Maintains diary system for case review and documents file to reflect the status and work being performed on the file assigned.
Communicates appropriate information promptly to the Area Manager and client to resolve claims efficiently, including any injury trends or other safety related concerns.
Adheres to all Company policies and procedures.
Conduct file reviews independently.
Other duties as assigned.
Essential job function.