Sr Claim Examiner- WC
Crawford•Dedham, MA
•Remote
About The Position
Investigate and settle advanced, large-loss, and complex claims promptly and equitably under minimal supervision. Work within established authority on moderate-to-difficult claims. Review coverage, determine liability and compensability, secure information, arrange property damage appraisals, and settle claims using claims best practices. Evaluate and set reserves using independent judgment. Assist supervisors and company attorneys in preparing cases for litigation. Conduct training and mentor new hires.
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 required according to jurisdictional requirements.
- Ability to work independently while assimilating various technical subjects.
- Strong written and oral communication, negotiation, and presentation skills.
- Advanced analytical and problem-solving skills, with 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, such as IIA, AIC, AEI, and/or CPCU.
Responsibilities
- Interpret and make decisions using independent judgment on complex and unusual policy coverages, 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, and authorize payments within the scope of authority.
- Settle claims cost-effectively and promptly, ensuring timely issuance of disbursements.
- Issue company drafts for claim 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
