[Hiring] Claims Representative II, Professional Liability @California Dental Association

Role Description

The Claims Representative II, Professional Liability is responsible for:

• Working with supervisor to identify, evaluate and make determinations on issues related to coverage.
• Investigating and making determinations related to cause and origin of loss and liability, including retaining and supervising outside adjusters, legal counsel, and other vendors.
• Managing the course of litigation, including the development of defense strategies and budgets in accordance with TDIC Litigation Guidelines.
• Attending meetings with policyholders, defense attorneys, and consultants, as well as trials, mediations, and settlement conferences with supervisor approval.
• Negotiating claim resolutions with claimants and/or their legal representatives under the direction of the claims supervisor.
• Maintaining assigned caseloads on a diary system, documenting claim files, and corresponding with insureds, vendors, claimants, and/or their legal representatives.
• Reviewing vendor bills and approving payments with supervisor guidance.
• Reviewing new claims with the supervisor to determine an appropriate course of action.
• Identifying cases of significance and preparing appropriate requests for authority from supervisor, management, and/or the Board.
• Attending mandatory meetings and pursuing educational opportunities with approval from the claims supervisor.

Qualifications

• High school diploma or GED.
• Minimum of three years insurance experience in a liability claims or similar position; or equivalent combination of education and experience.
• Experience in professional liability and/or general liability.
• General knowledge of state laws, insurance codes and principles, and applicable Civil Codes, Health and Safety Codes.
• Excellent interpersonal, verbal and written communication skills.
• Intensive communication with involved parties via phone.
• Ability to perform job duties under supervision.
• Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, attorneys, and independent adjusters.
• Ability to maintain confidentiality and demonstrate diplomacy and tact while interacting with all levels within and outside the organization.
• Ability to organize and prioritize caseload.
• Computer skills, including the ability to operate MS Windows Office, including experience with AS400 or other database management program.
• Regular auto/air travel required.

Requirements

• Associate’s or Bachelor’s degree with courses in insurance preferred.
• Commercial property insurance and in-person negotiation experience preferred.
• Experience with claims management and estimating software programs preferred.

Benefits

• Remote and hybrid flexibility and technology to support remote work.
• Generous time off program starting at 22 days of PTO and 13 paid holidays (includes a floating holiday and winter closure).
• Highly competitive medical, dental and vision plans, including FSA and HSA account options.
• 401(k) plans, with a generous match and safe harbor contributions upon eligibility.
• Paid parental leave.
• Wellness programs, including incentives and an In-Shape Family Fitness discount.
• Opportunities for professional development, training and leadership skill-building.
• Critical illness, accident, life, pet, short term and long-term disability insurance options.
• Employee Assistance Program (EAP) for support navigating day-to-day challenges.