Claims Examiner

Berkley • Moorestown, NJ

1d • Hybrid

About The Position

The Claims Examiner determines and discharges the company’s contractual obligations under its insurance policies, including coverage analysis, investigation, legal defense, and loss and expense reserving. The examiner records claims, reviews coverage applicability, establishes and maintains reserves based on investigation and legal discovery, and coordinates coverage questions, reserves, settlement authority, and large-loss reports with management and the Claims Committee.

The role provides direction to adjusters, investigators, and defense attorneys to support adequate claim handling; attends mediations and trials as necessary with supervision; reviews billing statements and processes them for payment; and stays current on applicable company procedures, case law, statutory requirements, and industry practices. The examiner also attends industry-related continuing education and performs additional assigned tasks. Up to 20% travel is required.

Requirements

• At least three years of progressive commercial insurance claims handling experience.
• Ability to assess priorities and manage deadlines effectively.
• Effective verbal and written communication skills.
• Strong research and analytical skills.
• Strong problem-solving and organization skills.
• Customer-service orientation.
• Proficiency with the MS Office Suite.
• Ability to travel up to 20%.

Nice To Haves

• Bachelor’s degree or equivalent work experience.

Responsibilities

• Incorporate claims into company records and review them for applicability of coverage.
• Analyze coverage, investigation, legal defense, and loss and expense reserving in determining the company’s contractual obligations.
• Discuss coverage questions, reserves, and settlement authority with the Manager and Claims Committee in accordance with best practices, including preparing large-loss reports.
• Present claim facts and recommendations to the committee as necessary.
• Establish initial loss and expense reserves and maintain valid reserves based on current investigation and legal discovery.
• Provide ongoing direction to adjusters, investigators, and defense attorneys to ensure claims are adequately handled.
• Attend and participate in mediations and trials as necessary, with supervision.
• Follow company procedures and guidelines, case law, and statutory requirements when coverage is in question or claims are paid or denied.
• Review trade journals and Unfair Claim Practice Acts to maintain current knowledge relevant to the role.
• Review incoming billing statements for accuracy and process them for payment.
• Attend industry-related seminars, workshops, and courses for continuing education.
• Complete additional tasks as assigned.

Benefits

• Medical, dental, and vision coverage.
• Flexible Spending Account, Health Savings Account, and Health Reimbursement Arrangement.
• Short- and long-term disability coverage.
• 401(k), profit sharing, and employee stock purchase plan.
• Life, accidental death and dismemberment, travel, and additional life insurance.
• Employee Assistance Program.
• Paid time off, including vacation, sick time, and holidays.
• Wellness program.
• Industry-related education and exams.
• Industry-related tuition assistance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level