Claims Examiner

Canopius•Chicago, IL

13d•$80,000 - $100,000

About The Position

The Role Provides oversight of personal and commercial lines property claims, including review and approval of claims exceeding the TPA’s authority. Analyses coverage and ensures that appropriate coverage letters are sent by the TPA. Participates in audits of assigned TPAs and ongoing review of monthly reports. Works with underwriting to provide relevant information on claims, coverage and agents.

Requirements

Bachelor’s degree or the equivalent in related work experience; five or more years of progressive technical claim experience is required
Thorough technical knowledge of commercial property claims practices and procedures; some D&F claim experience is preferred.
Thorough technical knowledge of commercial property coverage forms; first party commercial auto knowledge a plus.
Thorough functional knowledge of Microsoft Office tools, including Word and Excel
Willingness to learn and handle other lines of business based on workload and need
Self-starter with the desire to work in a collaborative environment and provide insight and feedback to other departments
Detail-oriented service professional with the ability to communicate effectively with adjusters, co-workers and clients
Strong analytical skills
Strong verbal and written communication skills
Good mathematical skills with ability to compute rate, ratio and percent and to draw and interpret bar graphs and tables.
Strong attention to detail and focused on the delivery of high-quality work
Highly motivated, enthusiastic and structured working style
Claims Evaluation
Claims Negotiation
Claims Strategy
Communication
Customer Relationship Management
Local Market / Policy Knowledge
Portfolio Management
Reading Comprehension
Third-Party Management
TPA / DCA Management

Responsibilities

Review claims submitted by TPAs and authorize reserves and payments where those amounts exceed the TPA’s authority
Provide guidance to TPAs to ensure proper investigation and timely, equitable disposition of claims, including retention of experts and/or attorneys where needed
Assist TPA with coverage analysis, seeking underwriting assistance where appropriate
Review and approve reservation of rights and coverage denial letters to ensure accuracy and consistency in coverage analysis
Review claims to ensure appropriate reserve levels and that changes are made on a timely basis
Refer claims in excess of authority to supervisor
Prepare notification to underwriters and reinsurers for large or contentious claims
Review and approve TPA funding requests within authority
Participate in claim file audits to monitor TPA performance
Assist with preparation of reports for underwriting, agents, insureds or state agencies as needed
Occasional travel
Other duties as assigned