Senior Claims Examiner - Claims Specialist - New York Labor Law

James River Holdings•Richmond, VA

43d•Remote

About The Position

Under minimal supervision, the Senior Claims Examiner - Claims Specialist manages a caseload of moderate to high complexity New York Labor Law commercial insurance claims. The incumbent will review claims to analyze and determine applicable coverage, facts, liability, damages, and plan for resolution in accordance with state and company guidelines. The incumbent will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims.

Requirements

Expertise in claim handling and suit management
Moderate to advanced knowledge of P&C insurance industry
Ability to effectively assess risk
Proficiency in MS Office (Word, Excel, Outlook)
Excellent written and verbal communication skills
Excellent organizational skills
Ability to take direction from management
Ability to work independently and take initiative
Ability to exercise sound judgement in making critical decisions
Research, analysis and problem-solving skills
Strong negotiation skills
Ability to build effective relationships with business partners
Ability to perform effectively as part of a team
Ability to organize complex information and pay close attention to detail
Ability to anticipate customer needs and take initiative to meet those needs
Ability to train and provide technical guidance to less experienced Claims professionals
Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter
High school diploma required
Bachelor's Degree preferred
Minimum of three years of New York Labor Law claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorney required

Nice To Haves

Adjuster license and/or certifications preferred
Advanced Degree or Juris Doctorate Degree preferred
Minimum of seven years of New York Labor Law claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
Adjuster license and/or certifications desired preferred

Responsibilities

Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
Perform coverage, liability, and damage analysis on all claims assignments
Investigate allegations and determine facts based on evidence and interviews
Draft disclaimers and reservation of rights letters when coverage issues arise
Assign limited investigations and appraisals to licensed insurance professionals
Manage a caseload of moderate to high complexity claims with delegated authority
Manage litigated files
Negotiate settlements, mitigate losses, and control expenses
Participate in and attend mediations to facilitate settlements
Maintain accurate documentation in claim files
Prepare correspondence to all required parties involved in a claim
Provide technical guidance, assistance, and training to Claims Associates and Claims Examiners
Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
Maintain a passing quality assurance score on all audits and QAs
Handle claims in accordance with established James River Claims Best Practices
Other duties as required by management