Position & Responsibilities:
In accordance with Company policies and in support of the Claims Department's mission, the Claims Examiner II has the responsibility to ensure outstanding claims service.
Promptly investigates each claim in accordance with the claims Department Best Practices.
Initiates contact with insureds, claimants, witnesses, attorneys and other appropriate parties.
Sets schedule for investigation, including determination of appropriate witnesses and parties to contact
Reviews and evaluates policy coverage provisions, business classifications and underwriting guidelines.
Makes recommendations regarding the handling of coverage issues.
Composes reservation of rights letters, non-waiver agreements and coverage declination letters.
May direct counsel on approved declaratory judgment actions.
Oversees and controls investigation assignments made to independent adjusters and other vendors.
Uses independent judgment to review and audits all vendor invoices.
Sets initial reserves and ensures proper reserve evaluations throughout the life of a claim.
Maintains an organized claim file, including appropriate file documentation.
Maintains an effective and timely diary in accordance with Best Practices.
Works with counsel to ensure they are in compliance with the Department's Litigation Management Plan and Billing Guidelines.
Uses judgment and discretion to equitably investigate, negotiate reserves and resolve all claims within the prescribed authority level, authorized by Senior Management.
Recognizes and pursues potential opportunities using experienced judgment for recovery including subrogation, indemnification and/or contribution.
Recognizes and refers potential suspicious claims or claims activity, based on experienced judgement, to the SIU in accordance with the Claims Department Best Practices.
Establishes and maintains business relationships with Underwriting and reinsurers, as well as agents, insureds attorneys, vendors and other parties as appropriate.
Provides timely and proper notification and updates to reinsurers.
Participates in weekly roundtable meetings on claims issues.
Completes special projects and performs other duties as assigned by the Claims Manager.
Requirements & Qualifications:
Ten years minimum of technical experience required.
Experienced claims professional who must possess a knowledge of coverage, statutory requirements and claims handling regulations.
High degree of technical skill and expertise required to recognize and resolve technical claims issues and recommend and implement solutions within the granted authority.
Requires excellent interpersonal skills and a high degree of initiative and decisiveness.
Shows ability to use independent judgment and discretion in decision-making, including claims analysis.
Ability to communicate with all levels of company management as well as the general public, attorneys and the company's general agents in a professional manner.
Must have strong analytical skills and knowledge of policy construction, and forms used by the Company.
Must have strong computer skills with knowledge of Windows operating systems plus Word, Excel, PowerPoint and ImageRight.
Must be able to effectively understand construction terminology, estimating systems, and building evaluations.
Knowledge of the legal invoice review process (TyMetrix software) is a plus.
Must possess or acquire adjuster licenses and complete CE requirements as needed.
Must be able to travel on company business as needed.
College degree or equivalent work experience required.
Additional insurance related education/designation such as CPCU, AIC, AIM, SCLA, etc, preferred.
Other advanced degrees are a plus.
Global Indemnity Limited