Claims Examiner - Hybrid

Arbella•Quincy, MA

2d•Hybrid

About The Position

Under general supervision, this role provides guidance and oversight in the investigation and disposition of auto and casualty claims that exceed the authority of Claim Offices. The Claims Examiner drives knowledge transfer and talent development by building mentor-level relationships and leveraging superior technical expertise in auto and casualty liability to deliver quality outcomes and exceptional customer experiences. This position maintains responsibility and oversight for PIP Litigation, including assignment, authority, and analytics. Key responsibilities include reviewing auto, casualty, and PIP claims above specified amounts or involving serious coverage questions, negotiating and making decisions on PIP Litigation assignment and settlement values, and reviewing/analyzing court decisions and legislation impacting claim handling. The role involves participating in claim investigations, negotiations, and settlements, providing technical assistance to claim personnel, and developing/maintaining claim handling procedures. The Claims Examiner also analyzes field reviews to ensure company policy implementation, counsels on identified problems, and participates in the preparation and dissemination of technical materials. Staying abreast of current trends and innovations affecting claim handling is crucial to ensure competitive claim service. Some direct handling of large losses, travel, and field work may be required. Establishing strong, collaborative relationships with Branch Claim Offices, including periodic visits, is essential. The role involves dynamic participation in Large Loss Roundtables, assisting in the identification and selection of experts, and delivering superior litigation, loss cost, and ALAE management results. This position serves as a key technical liaison between Home Office Claim and Branch Claim Offices for PIP Litigation, proactively monitoring changes in law, regulatory requirements, and loss trends, and developing solutions to minimize impact. Support and drive for strong fraud focus and partnership with SIU, effective engagement and utilization of resources, and a strong trial appetite are expected. Providing regular, constructive feedback to Claim Professionals, TMs, and Managers, and involvement in the development and delivery of technical training are also key aspects of this role. The position identifies and recommends talent development opportunities at various levels.

Requirements

Extensive claim work experience in PIP and BI with expert knowledge and ability to provide guidance and direction to Claim employees.
Make effective judgements on the most complex claims.
Excellent ability to train and mentor employees and develop training materials.
Strong relationship building, communication and collaboration skills.

Responsibilities

Reviews auto, casualty, and PIP claims that are above specified amount or involve serious coverage questions.
Negotiates and makes decisions on PIP Litigation assignment, settlement values, and proper disposition.
Reviews and analyzes court decisions and legislation which may impact on claim handling and advises field on all important developments and trends.
Participates in the investigation, negotiation and settlement of selected claims.
Provides technical information and assistance to claim personnel on claims not filed or reviewed in the Home Office when requested and visits Claim Offices on occasion to discuss technical or communication problems.
Develops and maintains claim handling procedures for claim offices in a specific line of insurance and analyzes field reviews to assure that company policy and procedures are being implemented in the field.
Counsels with Home Office and Claim Office personnel on problems that were identified by the field reviews.
Participates in departmental preparation, dissemination and implementation of technical materials, source materials and other work tools.
Keeps abreast of current trends and innovations which affect claim handling to assure that our claim service is competitive.
Establish strong, collaborative and supportive relationships with Branch Claim Offices; including periodic visits to assigned offices.
Drive knowledge transfer and talent development while developing “mentor” level relationships.
Dynamic participation in Large Loss Roundtables.
Assist in the identification and selection of experts; includes assistance in defining specific question(s) expert should be addressing.
Deliver superior litigation, loss cost and ALAE management results on assigned losses as well as providing technical support to Branch Claim Offices in their achievement of the same objectives.
Key technical liaison between Home Office Claim and BCOs for PIP Litigation.
Proactively monitor changes in law, regulatory requirements and loss trends and actively engage in the development of requisite solutions to minimize impact to claim outcomes and customer experience.
Support and drive strong fraud focus and partnership with SIU.
Encourage and actively support effective engagement and utilization of all available resources.
Drive strong, yet appropriate trial appetite.
Provide regular, constructive feedback to Claim Professionals, TMs and Managers.
Involvement in the development and delivery of technical training.
Identify and recommend talent development opportunities at Claim Professional, TM, and Manager levels.
Performs other related work as required or requested.