Liability Claims Examiner

Vanguard Claims Administration•Woodbury, NJ

About The Position

We currently have an opening for a Liability Claims Examiner. The role of Vanguard’s Liability Examiner is to investigate and evaluate insurance claims, determining liability, handling construction defect and managing the claims process, often including litigation and settlement negotiations, to ensure timely and cost-effective resolutions for our clients.

Requirements

A High School Diploma or Equivalency is required.
At least 3-5 years’ experience in liability claims handling required.
Property and Casualty Insurance policy knowledge; proficiency in writing and research; knowledge and understanding of Property/Casualty policies
Understanding of insurance coverage issues; understanding of the workings of Underwriters at Lloyds of London; a basic understanding of tort law and state mandates standards of negligence standards
Required State licenses (must obtain applicable state licenses)
Strong written/oral communication and interpersonal skills.
Ability to manage a pipeline of claims and have strong organizational skills.
Proven ability to provide exceptional customer service.
Computer skills with the ability to work with multi-faceted systems.
Strong proficiency in Microsoft Office Suite and experience with Claims Management Systems.

Nice To Haves

Insurance designations (AIC, CPCU) preferred.
The ability and willingness to assist other departments as company needs arise.

Responsibilities

Handling liability and construction defect claims from inception until completion
Reviewing liability claims, litigated by counsel or insurance adjuster managed
Maintaining a point person role reporting to the proper client and ensuring all time lines are properly followed
Resolving claims by denial, settlement or referral to another insurance company
Performs complete liability, coverage and bodily injury investigations
Reviews and evaluates claim based on evidence obtained to determine responsible parties, liability exposure, questions of fraud or other pertinent issues
Claims in Construction Defects are often involved and require contract analysis, managing litigation/arbitration with numerous defendants and coverage issues that may involve multiple policy years, varied insurers and types of insurance coverage specific to the construction trades industry
Reads, analyzes and interprets insurance policies and endorsements, applicable state and local statutes, case law and applies to claim situations
Orders bills and reports from medical providers of injured parties, obtain police/ambulance/fire reports, medical histories and ISO reports to determine facts and prior accident information
Prepares and maintains file documentation, communicates with insureds, claimants or attorneys regarding progress of claim
Negotiate settlements of claims with insureds, claimants and others up to authority limits
Draft reports to clients with recommendations for claim disposition
Attend Mediations/Arbitrations/Trials as necessary
Manage legal expenses, reserves and financial transactions
Handle all claimant, policyholder, client, and company information in accordance with SOC 2 security, confidentiality, and data integrity standards.
Ensure sensitive data is stored, transmitted, and processed securely, following company policies and procedures.
Maintain accuracy and completeness of information in all systems, reports, and documentation.
Promptly report any actual or suspected security incidents, policy violations, or data handling concerns to management.
Participate in training and awareness initiatives to stay current on SOC 2 requirements and best practices.
Support audit readiness by providing documentation, evidence, or explanations of compliance activities when requested.
Performs additional responsibilities as needed to support business operations and compliance objectives.