Professional Liability Claims Examiner III

Tristar Insurance•Atlanta, GA

1d•$80,000 - $95,000•Remote

About The Position

Responsible for the prompt review and interpretation of policy information, including all applicable endorsements and vehicle schedules, to determine coverage for loss, damage, or injury. Conduct thorough and efficient claim examinations and investigations leading to the final resolution of complex Commercial Automobile and General Liability casualty claims, including matters in litigation. The position requires frequent communication and interaction with insureds, claimants, attorneys, clients, experts, vendors, and other involved parties. Effectively communicate claim exposure, reserve recommendations, settlement strategies, and resolution plans to the client. This is a remote, work-from-home position. The employee must maintain a professional and secure work environment suitable for handling confidential company, client, and claimant information.

Requirements

High school diploma or GED required.
A minimum of seven years of progressively responsible experience handling complex Commercial Automobile and General Liability casualty claims is required.
Seven to ten years of Commercial Automobile and General Liability claims-handling experience.
Advanced knowledge of claims-handling principles, practices, and procedures, including policy interpretation, coverage analysis, liability assessment, damage evaluation, reserving, negotiation, and settlement.
Demonstrated ability to independently manage complex, high-exposure, and litigated claims.
Strong understanding of the litigation process, litigation management, and case valuation across multiple jurisdictions.
Working knowledge of applicable statutory and regulatory requirements.
Knowledge of medical terminology and the ability to evaluate medical records, treatment, causation, and bodily injury damages, when applicable.
Advanced analytical, critical-thinking, problem-solving, decision-making, and negotiation skills.
Ability to evaluate complex information, exercise sound judgment, and make well-supported claim recommendations with minimal supervision.
Excellent verbal and written communication skills, including the ability to clearly communicate complex or technical information to clients, claimants, attorneys, and internal staff.
Ability to establish and maintain effective working relationships with individuals at all levels of the organization and with external business partners.
Excellent customer-service and relationship-management skills.
Ability to manage competing priorities and meet deadlines in a fast-paced environment.
Strong organizational, time-management, documentation, and follow-up skills.
Ability to understand and carry out detailed written and verbal instructions.
Ability to work independently while demonstrating sound judgment, flexibility, initiative, and creativity.
Proficiency with claims-management systems and standard business applications, including Microsoft Word, Excel, and Outlook.
Must possess and maintain all adjuster licenses required to handle assigned claims.
Must be able and willing to obtain additional licenses through designated-home-state reciprocity or applicable state adjuster examinations.

Nice To Haves

Bachelor’s degree in business, insurance, risk management, or a related field preferred.
An equivalent combination of relevant education, training, and experience may be considered.
Multi-state adjuster licensure is strongly preferred.
Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other relevant insurance designation preferred.

Responsibilities

Review, investigate, evaluate, negotiate, process, and resolve assigned complex Commercial Automobile and General Liability casualty claims.
Review and interpret policies, endorsements, vehicle schedules, and other relevant documentation to make appropriate coverage determinations.
Analyze coverage, liability, causation, damages, and potential exposure.
Oversee and direct outside service providers, including investigators, appraisers, experts, and other vendors.
Work closely with clients, client counsel, defense counsel, and investigative service providers to advance claims toward resolution.
Manage litigated claims, including evaluating litigation strategy, reviewing legal reports, monitoring discovery and trial activity, and assessing case value.
Maintain an accurate and timely diary system and complete all required follow-up activities.
Continually assess claim exposure and establish or recommend accurate reserves and settlement strategies.
Prepare comprehensive loss reports that include a thorough analysis of coverage, liability, damages, litigation status, exposure, reserves, and recommended next steps.
Identify potential subrogation, contribution, indemnification, or other risk-transfer opportunities and initiate recovery efforts at the direction of the client.
Accurately and timely document all correspondence, reports, discussions, evaluations, recommendations, and claim decisions in the claim file.
Independently manage a caseload of complex claims in accordance with company guidelines, client service instructions, applicable regulations, and industry best practices.
Provide timely, professional, and responsive service to clients and other involved parties.
Assist supervisors and the Claims Department with requested assignments and special projects.
Comply with all company policies and procedures.
Perform other duties as assigned.