Sr Claim Examiner- WC
About The Position
Investigates and settles advanced, large-loss, and complex claims promptly and equitably under minimal supervision, working within established authority on moderate-to-difficult claims. Reviews coverage, determines liability and compensability, gathers information, arranges property damage appraisals, and settles claims using claims best practices. Evaluates and sets reserves using independent judgment and assists supervisors and company attorneys with litigation preparation. The role also conducts training and mentors new hires. The examiner interprets complex and unusual policy coverage, manages investigations, and directs discovery and litigation strategy with legal counsel. The role analyzes claims activity, prepares reports, participates in claim reviews, establishes reserves, authorizes payments within the scope of authority, settles claims cost-effectively, and develops subrogation and third-party recovery opportunities.
Requirements
- Bachelor's degree or equivalent experience.
- Four to eight years of technical claims investigation and settling experience in Claims or a similar organization.
- Workers Compensation (WC) Adjuster License, as required by jurisdiction.
- Ability to work independently while assimilating various technical subjects.
- Strong written and oral communication, negotiation, and presentation skills.
- Advanced analytical and problem-solving skills, including the ability to manage and prioritize multiple projects.
- Advanced interpersonal skills to interact effectively with all levels of internal and external clients.
Nice To Haves
- Industry designations preferred but not required: IIA, AIC, AEI, and/or CPCU.
Responsibilities
- Interpret and make decisions about complex and unusual policy coverage, determining whether coverage applies to submitted claims.
- Manage all aspects of investigative activity on complex claims.
- Direct discovery and litigation strategy with legal counsel.
- Analyze claims activity and prepare reports for clients, carriers, and management.
- Establish reserves using independent judgment and expertise.
- Authorize payments within the scope of authority, settle claims cost-effectively, and ensure timely issuance of disbursements.
- Settle claims promptly and equitably and issue company drafts for payments within authority limits.
- Develop subrogation and third-party recovery potential and follow reclaim procedures.
- Participate in claim reviews.
- Assist supervisors and company attorneys in preparing cases for litigation.
- Conduct training and mentor new hires.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
