The Senior Liability Claims Examiner provides prompt, courteous and fair claim service on homeowners liability and commercial general liability property damage and bodily injury claims from initial claim set up through claim resolution, including litigation. This position will entail the handling of multi-jurisdiction personal homeowners liability claims with heavy focus on commercial general liability, condominium and construction defect claims.
Duties/Responsibilities:
Makes timely initial contact and appropriate follow up contact with all relevant parties to provide explanation of claim process, set expectations, gather facts and provide information on developments.
Performs and documents initial coverage analysis and recognizes potential coverage issues
Conducts, directs and/or oversees the development of facts necessary to address coverage, liability and damage aspects of the claim
Evaluates facts to properly analyze applicable coverage issues
Drafts coverage letters including declinations, reservation of rights, excess and partial denials
Applies relevant jurisdictional laws and uses independent judgement to reach liability determinations based upon the facts
Gathers appropriate supporting damage documentation and evaluates amounts owed based upon analysis of coverage, liability and relevant jurisdictional laws
Effectively communicates claim decisions verbally and in writing to policyholders, claimants, attorneys and agents
Properly updates claim file with key activities and documents
Maintains effective diary system to bring claims to timely resolution
Communicates effectively with internal business partners including Customer Service and Underwriting
Develops constructive relationships and works effectively with outside vendors such as independent adjusters and defense counsel
Establish appropriate reserves based upon competent analysis of coverage, liability and damages and adjust reserves as necessary in a timely manner upon receipt of additional relevant information.
Apply common sense and cost-benefit analysis to claim decisions
Complete necessary claim reporting to management including high exposure alert notifications
Evaluates and resolves liability claims within scope of authority
Conducts Medicaid/Medicare reporting in accordance with federal law
Reviews invoices for accuracy and completes timely expense and indemnity disbursements assuring compliance with tax reporting requirements
Oversees handling of cases in litigation and provides appropriate guidance to defense counsel
Attends and actively participates in mediations and other forms of alternate dispute resolution where required by the court or where appropriate to move the claim to a timely and proper resolution
Recognizes potential third party tortfeasors and develops facts to support the likeliness of successful recovery
Prepares appropriate claim updates for management and excess carriers
Participates in claims reviews presents issues and recommendations in a precise and understandable manner
JOB REQUIREMENTS SKILLS AND ABILITIES:
Exceptional customer service skills
Emotional intelligence and ability to manage conflict
Advanced analytical, problem-solving and decision making skills
Ability to communicate effectively verbally and in writing with varying audiences
Excellent negotiation skills and track record of proven results
Team-player who is comfortable working in a dynamic, entrepreneurial environment
Willingness to simultaneously work on multiple projects and fulfill multiple roles
Proven leadership and mentoring capabilities
Ability to interpret a variety of policy forms and endorsements
History of litigation claims management and working effectively with defense counsel
Familiarity with reading and interpreting contracts, statutes and case law
Strong computer skills and advanced knowledge of Microsoft products
QUALIFICATIONS:
Bachelor's degree or higher
7 years liability claim handling experience (multi-jurisdiction preferred)
5 years bodily injury evaluation and negotiation experience (serious injury preferred)
5 years commercial general liability claim handling
Condominium claim handling and ability to read and interpret condominium and property management documents preferred
Licensed to adjust claims in Florida (multi-state licensing preferred)