Insurance Claims Examiner

 

JOB PURPOSE:  Provide quality customer service and ensure file quality.

 

ESSENTIAL JOB REQUIREMENTS:

 

Possess General Liability claim experience with current knowledge of jurisdictional laws and regulations. 

 

Possess basic oral and written communication skills along with computer skills.

 

Possess basic negotiation and customer service skills.

 

Provide timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. 

 

Investigate each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.  Take necessary statements.

 

Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.

 

Maintain an effective diary management system to ensure that all claims are handled timely.

 

At required time intervals, evaluate liability & damages exposure, and establish proper indemnity & expense reserves. 

 

Handle all claims within delegated authority, promptly and properly.  Negotiate disposition of claims with insureds and claimants or their legal representatives.  Recognize and implement alternate means of resolution.

 

Manage litigated claims.  Develop litigation plan with staff or panel counsel, track and control legal expenses.  Assure cost-effective resolution.

 

Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.



Maintain claim files, have an effective diary system, and document claim file activities in accordance with established procedures.

 

Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.

 

Performs all other functions as required.