Job Summary

The Claims Examiner l will manage a caseload of low to moderate severity/complexity property and casualty insurance claims under a moderate level of supervision, depending on level of experience.  Job functions include the following:  Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of insured’s or insurer’s liability; Reviewing and evaluating damages and determining strategies for resolution.   Settling claims in accordance with policy provisions and within an authority level. The Claims Examiner l will engage in verbal and written communication with claimants, attorneys, and policyholders.  The Claims Examiner l will ensure that all state claims handling requirements are met and internal guidelines are followed. The Claims examiner l will handle claims in accordance with established James River Claims Best Practices.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Perform coverage, liability, and damage analysis on all claims assignments
• Prepare correspondence to all required parties involved in claim when necessary
• May investigate allegations and determine facts based on evidence and recorded interviews
• May be required to complete actions to satisfy department of insurance and/or state regulations
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to licensed insurance professionals
• Negotiate settlements, mitigate losses, and control expenses
• Maintain a high level of communication internally with claims management team and externally with insureds, claimants, and attorneys
• May be called upon to assist in training existing and new Claims Examiners

Knowledge, Skills and Abilities

• Excellent written and verbal communication skills
• Strong analytical skills
• Strong negotiation skills
• Ability to work independently with moderate level of supervision
• Excellent organizational skills
• Proficiency in MS Office (Word, Excel, Outlook)
• Ability to work in a team environment and take direction from Claims Manager
• Ability to train and provide technical guidance to less experienced Claims Examiners
• Functional knowledge and skills reflective of a fully competent Claims Examiner
• Ability to successfully obtain the required state adjusters’ licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter.

Experience and Education

Claims Examiner

• High school diploma required
• Bachelor’s Degree preferred
• Minimum of one year of P&C claims handling experience including handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
• Adjuster license and/or certifications preferred

Senior Claims Examiner

• High school diploma required
• College degree preferred
• Minimum of five years P&C claims handling experience
• Experience and proven track record in managing complex coverage issues and complex litigation
• Multi-jurisdictional claims experience
• Adjuster license and/or certifications preferred

Claims Specialist

• High school diploma required
• College degree preferred
• Advanced degree or law degree preferred
• Minimum of seven years claims handling experience
• Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
• Experience working with complex coverage issues
• Multi-jurisdictional claims and litigation experience
• Adjuster license and/or certifications desired preferred

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