Professional Liability Claims Examiner III

Tristar Insurance•Atlanta, GA

39d•$80,000 - $95,000•Remote

About The Position

The Claims Examiner III manages professional liability claims from initial report through resolution, within established authority and company guidelines. The role reviews policy information, including endorsements and vehicle schedules, to determine coverage for loss, damage, or injury, and conducts claim examination and investigation through final resolution, including claims in litigation. The position involves frequent interaction with claimants, their legal representatives, clients, client counsel, and investigative service providers. The examiner communicates recommendations concerning loss exposure, reserves, and settlement strategy to the client. The role reports to the Claim Supervisor and/or Area Manager and works under the oversight of the Area Manager. It is remote and performed from home.

Requirements

Five or more years of related experience, or an equivalent combination of education and experience.
Active Independent Adjuster New York State License.
Technical knowledge of coverage, statutory regulations, and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff.
Ability to interact with people at all levels in a business environment.
Ability to independently and effectively manage very complex claims.

Nice To Haves

Bachelor’s degree in a related field.
Proficiency in Microsoft Word and Excel.

Responsibilities

Review, process, investigate, evaluate, and conclude assigned professional liability claims.
Review and interpret policies and determine coverage.
Oversee and direct outside investigative service providers, and work with the client, client counsel, and investigative services to advance claims to conclusion.
Maintain an ongoing diary for claims.
Continually assess exposure and evaluate reserves and settlement recommendations.
Prepare Loss Reports with analysis of liability and damages.
Determine when subrogation and/or risk transfer exists, where applicable, and initiate recovery efforts at the direction of the client.
Document correspondence, reports, discussions, and decisions in claim files.
Provide outstanding service to the client.
Assist Supervisors and the Claim Department with requested tasks or special projects.
Perform other duties as assigned.