Senior Claims Examiner P&C - Public Entities

Athens Administrators•Orange, CA

8d•Hybrid

About The Position

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support public entity and special district accounts for our Property & Casualty department. This Examiner must reside in California in order to attend file reviews and meetings. Employees who live less than 26 miles from the Concord or Orange offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday through Friday at 37.5 hours per week. The Senior Claims Examiner is responsible for the review, analysis and processing of complex general liability and auto claims within assigned authority limits and consistent with policy and legal requirements. These multi-line claims are typically high exposure and involve municipalities and small public agencies that participate in a municipal self-insurance pool. Claims may involve complex litigation, coverage issues, and highly sensitive matters that may receive media attention. The goal of the position is to ensure quality service to our members while protecting their interests and working toward the best possible resolution of their claims.

Requirements

High School Diploma or equivalent (GED) required for all positions
Minimum 8-10 years of complex/major claims experience including proficiency in investigation and resolution of severe to major casualty general liability and commercial auto claims
Proficiency in investigation and resolution of mid-level to high level exposures
Familiarity and understanding of the handling standards and requirements of public entities and special districts, including but not limited to due process and procedure, abuse, molestation, assault, premise, educators/administrators, Director and Offices and school or public officials preferred
Experience with relevant CA insurance laws, codes, and procedures
Proficiency in investigation and resolution of mid to high-level public entity claims preferred
High exposure general liability and commercial auto experience preferred
Experience with property and casualty insurance policies, insurance tort laws, codes and procedures
Understanding of medical, legal terminology and liability concepts
Proficiency in investigation and resolution of severe to major-level casualty claims
Ability to evaluate contracts and review policies for coverage
Understanding of premise liability and risk transfer concepts
Strong negotiation skills and ability to achieve optimal settlement results for clients.
Time Management and project management skills
Well-developed verbal and written communication skills with strong attention to detail
Excellent organizational skills and ability to multi-task
Ability to type quickly, accurately and for prolonged periods
Proficient in Microsoft Office Suite
Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
Must be able to reliably commute to meetings and events as required by this position

Nice To Haves

AA/AS or BA/BS preferred but not required

Responsibilities

Advanced knowledge in claims handling concepts, practices, and techniques specific to the California government code and regulations
Functional knowledge of CA law and insurance regulations
Demonstrated advanced verbal and written communications skills
Demonstrated advanced analytical, decision making and negotiation skills
Organize and effectively manage a caseload of general liability claims and new loss assignments venued in California
Investigate, evaluate, and determine settlement value or denial of liability for severe to major-level general liability and auto claims
Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy.
Make recommendations to set reserves at an appropriate level for claims outside of authority level.
Notify excess and reinsurance carriers of potential serious exposures in compliance with policy documents governing coverage.
Prepare comprehensive reports as required.
Identify and communicate specific claim trends and account and/or policy issues to management.
Manage the litigation process through the retention of counsel.
Adhere to the line of business litigation guidelines to include budget, bill review and payment.
Document and manage claims (i.e.: record statements, updated diaries, write reports) from inception through closure
Ensure appropriateness of all payments
Capability to adjust large multi-exposure general liability and commercial claims for both Bodily Injury and Property Damage
Exchange information with clients, claimants, insurance brokers, inspectors producers and account managers
Attend meetings and educational seminars for professional development.
Coordinate and work with a vendor services such as contractors, emergency repair, cleaning services and various replacement services.
Lead and conduct comprehensive file reviews and case analysis discussions with legal representatives and officials for the account, as well as city staff members.
Facilitate between claimants, clients, advisors, board member representatives, administrators, and attorneys in resolution of liability claims.
Provide the client and member with timely and ongoing claim status updates.
Superior customer service and communication skills.
Your day-to-day communication will include the client, defense counsel, and City staff, including City Clerks, City Managers, City Attorneys, Risk Managers, police staff and other key contacts.
Participate in mediations, settlement conferences, and file reviews, either in person or remotely.