Professional Liability Claims Examiner III

Tristar Insurance•Irving, TX

1d•$80,000 - $95,000•Remote

About The Position

Under the oversight of the Area Manager, the Claims Examiner III reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority and company guidelines. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

Requirements

Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
Technical knowledge of coverage, statutory regulations, and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
Ability to interact with people at all levels in the business environment.
Ability to independently and effectively manage very complex claims.
Active Independent Adjuster New York State License
Reasoning development: Solve practical problems; variety of variables with limited standardization; interpret instructions.
Mathematical development: Arithmetic calculations involving fractions, decimals, and percentages.
Language development: Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Physical Effort: Light work: Exerting up to 20 pounds of force occasionally Exerting up to 10 pounds frequently Exerting a negligible amount of force constantly to move objects.
Visual requirements: Near vision: clarity of vision at 20 inches or less.
Physical activity: Reaching, Standing, Walking, Pushing, Pulling, Foot Motion, Lifting, Fingering, Grasping.
Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
Repetitive Motion: Substantial movements (motions) of the wrists, hands, and/or fingers.

Nice To Haves

Proficient in Word and Excel (preferred).

Responsibilities

Review, process and conclude assigned claims including investigation and evaluation of professional liability claims.
Review and interpret policies, coverage determination.
Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
Maintain an ongoing diary.
Continually assess exposure and evaluate accurate reserves and settlement recommendation.
Prepare Loss Reports providing thorough analysis of liability and damages.
Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
Document all correspondence, reports, discussions and decisions in the claim file record.
Provide outstanding service to the client.
Assist Supervisors and Claim Department with requested tasks or special projects.
Other duties as assigned.