Senior Claims/TPA Oversight Examiner

Enstar Group

6d•$95,000 - $135,000•Onsite

About The Position

The Senior Claims Examiner is responsible for adjusting claims and/or providing TPA oversight of the various entities under management. The role requires the ability to deal with a wide range of losses including high value and complex claims. The examiner, with minimal oversight, will lead and direct junior examiners, TPAs, and vendors. The role is responsible for performance, development, and coaching to maximize performance.

Requirements

Technical knowledge of Property & Casualty claims
Significant experience (8+ years) in adjusting claims relevant to the classes of business handled
Good knowledge of contract wordings, coverage, and reinsurance structures
Detailed understanding of good faith claims handling
Working knowledge of State specific Claims Handling Guidelines
General understanding of legal principles as they pertain to insurance claims.
Ability to serve as a resource, train, and mentor junior staff, based on being an expert within the organization
Analytical skills
Knowledge of insurance regulations and industry best practices
Ability to work independently
Excel proficiency
Maintain applicable adjuster licensing

Nice To Haves

Bachelor’s degree preferred
Experience managing a Casualty and/or Professional Liability portfolio preferred
Exposure to participation in due diligence reviews preferred
Presentation skills
Understanding of actuarial concepts

Responsibilities

Ensure that implications for stakeholders, particularly policyholders, are given appropriate consideration in our business approach to deliver fair customer outcomes.
Adjust claims either via paper or electronic presentations as required for all Syndicates and/or Group Companies.
Investigate, evaluate, negotiate, and adjudicate claims within authority and in a manner that consistently meets or exceeds our Claims Policies and Procedures.
Assist with initial triage, onboarding reviews, and scheduling of roundtable discussions.
Provide coaching, feedback, and direction on claims.
Manage the Claim Status Report documentation process.
Ensure all data is concise and accurate in electronic claim systems.
Use electronic diary systems to manage all claims.
Utilize data including loss runs to manage claims.
Set appropriate and accurate case reserves in accordance with the company’s reserving philosophies.
Manage attorneys and negotiate and liaise with co-insurers.
Negotiate settlements as part of the market and pro-actively seek to identify and progress direct settlements solely for Enstar companies or to extend market settlements to other Enstar companies.
Report claim developments and account information to management and the Litigation Legal team as applicable.
Contract interpretation, managing cedant relationships and legal representation.
Conduct inspections of records when required and negotiate equitable claim resolution.
Monitor and oversee external agreement parties against SLAs and report any performance issues to Management.
Comply with Enstar claims handling authority levels.
Support and assist Outwards, Commutation and Complex Claims teams as required.
Carry out duties within internal policies and procedures in accordance with applicable law, rules, regulation, good governance and Enstar’s shared values, including putting clients at the heart of our business.
Work with external customers to address questions, resolve problems, and maintain rapport.
Assist with the Reinsurance reporting process.
Maintain applicable adjuster licensing.
Serve as the lead and primary point of contact for TPAs and vendors.
Resolve complex claims issues and disputes.
Provide analysis of claims data, metrics, and results from TPA performance to effectively manage a portfolio of claims. Ability to communicate points and conclusions to relevant parties in a matter that matches the given audience’s need to level of detail and communication preferences.
Provide periodic reports to management.
Coordinate claim reviews and provide data summaries.
Drive the performance management process for TPAs by communicating expectations, monitoring and evaluating performance, providing feedback and facilitating development.
Maintain transparent communication by appropriately communicating organizational information to TPAs through meetings, emails and regular communications.
Manage corporate expenses by monitoring file allocations, resources and other expenditures to ensure appropriateness.
Ensure compliance with all legal, regulatory, and internal control requirements.
Provide claims insights to assist other business units by collaborating on data analysis and trends.
Maintain professional and technical knowledge by attending educational workshops, professional publications, establishing personal networks, and participating in professional societies.

Benefits

Medical, Dental, and Vision healthcare for single and family coverage.
Virtual 24/7 urgent care access with board-certified doctors and pediatricians.
Health Savings Account (HSA) or Flexible Spending Account (FSA).
Dependent Care FSA to cover daycare expenses.
Employee Assistance Programs (EAP) for health and well-being.
Optional Pet & Home/Auto Insurance.
Wellness Reimbursement program (up to $600 annual reimbursement for wellness-related expenses, i.e., gym memberships, massage, etc.).
401K retirement plan (company matches up to 6% of employee contribution).
One paid annual volunteer day.
Professional Qualifications and Study Support
Training, Conferences & Seminars
Digital Learning Hub (LinkedIn Learning)