Senior Claims Examiner (Auto/General Liability Focus)

Alliance Member Servic

152d•Remote

About The Position

Nonprofits Insurance Alliance (NIA) is seeking a Senior Claims Examiner with a focus on Auto/General Liability. This role reports to the Claims Manager or Chief Claims Officer and involves managing a caseload of complex and high-exposure claims, as well as claims of lesser severity as needed. The Senior Claims Examiner will investigate, evaluate, and settle claims within their designated authority, and will be responsible for assigning and directing independent adjusters, appraisers, and defense attorneys. The ideal candidate will have over 10 years of carrier experience, the ability to work independently and collaboratively, and prior remote work experience. Experience in Employment Practices Liability (EPLI), specialty lines, or Major Case Unit (MCU) is a plus.

Requirements

Requires highly technical claim management skills, and significant knowledge of and experience with more than one of the following: Employment Practices Liability, Social Service Professional, Sexual Abuse, General Liability, and/or Business Auto; or Commercial Property expertise.
Ability and willingness to obtain adjuster licenses as needed in various states.
Demonstrates a thorough knowledge of current tort law and case law trends with respect to all casualty lines of business, civil procedure, insurance policy(s) and contract(s).
Must demonstrate good written and oral communication skills.
Must be organized and possess strong follow-up skills.
Requires the ability to analyze and apply creative solutions to claim issues.
Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details.
Strong negotiating skills, excellent telephone, written and verbal communication skills are essential.
Possesses and regularly demonstrates objectivity and pragmatism as well as strong conflict resolution skills.
Ability to manage total loss cost outcomes including ALAE to achieve superior results for our members and the company.
Incumbent must be aware of and follow guidelines concerning confidentiality.
The position communicates with legal and medical personnel, third party claimants, policyholders, producers, Reinsurers, and senior level staff throughout the company.
Demonstrated capability for working with a high level of independence.
Ability to deliver results in a fast-paced environment.
Positive approach, can-do attitude, flexibility and ability to operate with grace under pressure.
Ability to model and uphold appropriate professional boundaries in work with member-insureds.
Collaborate with other staff members and external partners.
Interest and commitment to the mission of the organization.
Commitment to inspired service.
Communicate effectively orally and in writing.
While performing the duties of this job, the employee is regularly required to bend, reach or sit for up to 3 hours at a time.
Must have adequate vision (with corrective lenses, or other accommodative devices if needed) to clearly view computer screen.
Must have adequate hearing to perform job tasks.
PC literacy required; proficiency in Windows, Word, and Outlook preferred.
Travel required as necessary and must be able to be productive while traveling on business, including the ability to utilize laptops and other business tools as provided, subject to reasonable accommodation, if needed.
Must have adequate hearing to perform job tasks.
Ability to mentor peer groups or more junior claims staff, as requested.
The position generally requires a minimum of ten or more years of progressively more difficult claims handling experience.

Nice To Haves

Heavy employment practices liability (EPLI), specialty lines, or major case unit (MCU) experience a plus.
Four year college degree or equivalent business experience.

Responsibilities

Determines applicable coverages for loss.
Investigates, manages, and resolves claims in a timely, unbiased, and informed manner in compliance with company policies, state laws, and regulatory performance standards.
Sets and maintains adequate claim reserves based on case facts and in accordance with company policy.
Conducts investigations, assigning fieldwork as necessary and appropriate, in accordance with company standards.
Determines liability.
Evaluates and pays claims within designated authority.
Presents coverage and claims analysis to management and makes recommendations on the resolution of disputed items when requested.
Sets reserves up to the position's level of authority.
Prepares and presents verbal and written claim status reports in accordance with company policy and pursuant to Reinsurance treaty requirements.
Recommends payment, evaluates and reserves claims, and reports to the manager cases exceeding designated authority, as well as to Reinsurers pursuant to treaty requirements.
Manages legal aspects through timely assignment of litigated cases to defense counsel, and ongoing evaluation of the legal process and expenses.
Maintains electronic files necessary for documentation of the claim file.
Analyzes and regularly reports to the Claims Manager on the performance of defense counsel.
Represents the company at litigation-related settlement conferences, mediation, and arbitration when needed.
Works closely with outside counsel to monitor claims and work with insureds to resolve underlying litigation.
Participates in both internal and external audits as needed.
Participates in weekly department meetings and Claims Committee Meetings as needed.
Promotes the team approach to case and account management.
Participates in marketing presentations and training programs as needed.
Provides accurate, courteous, and timely information to all external and internal customers concerning claims status and other inquiries.
Other duties as assigned.