Senior Claims Examiner - Claims Specialist - Construction Defect

Job Summary

Under minimal supervision, the Senior Claims Examiner manages a caseload of moderate to high complexity P&C insurance claims. The Senior Claims Examiner will review claims to analyze and determine applicable coverage, facts, liability, damages, and plan for resolution in accordance with state and company guidelines. The Senior Claims Examiner will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims.

Under minimal supervision, the Claims Specialist manages a caseload of high complexity P&C insurance claims. The Claims Specialist will review claims to analyze and determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty.

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
• Investigate allegations and determine facts based on evidence and interviews
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to licensed insurance professionals
• Manage a caseload of moderate to high complexity claims with delegated authority
• Manage litigated files
• Negotiate settlements, mitigate losses, and control expenses
• Participate in and attend mediations to facilitate settlements
• Maintain accurate documentation in claim files
• Prepare correspondence to all required parties involved in a claim
• Provide technical guidance, assistance, and training to Claims Associates and Claims Examiners
• Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
• Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
• Maintain a passing quality assurance score on all audits and QAs
• Handle claims in accordance with established James River Claims Best Practices
• Other duties as required by management

Knowledge, Skills and Abilities

• Expertise in claim handling and suit management
• Moderate to advanced knowledge of P&C insurance industry
• Ability to effectively assess risk
• Proficiency in MS Office (Word, Excel, Outlook)
• Excellent written and verbal communication skills
• Excellent organizational skills
• Ability to take direction from management
• Ability to work independently and take initiative
• Ability to exercise sound judgement in making critical decisions
• Research, analysis and problem-solving skills
• Strong negotiation skills
• Ability to build effective relationships with business partners
• Ability to perform effectively as part of a team
• Ability to organize complex information and pay close attention to detail
• Ability to anticipate customer needs and take initiative to meet those needs
• Ability to train and provide technical guidance to less experienced Claims professionals
• 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

Senior Claims Examiner

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

Claims Specialist

• High school diploma required
• Bachelor’s Degree preferred
• Advanced Degree or Juris Doctorate Degree preferred
• Minimum of seven years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
• Adjuster license and/or certifications desired preferred

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