[Hiring] Commercial Auto No Fault / PIP Claims Examiner III @Tristar Insurance

Role Description

Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

Duties and Responsibilities

• Review and interpret coverage, process, and conclude assigned Personal Injury Protection (PIP) claims including investigation and evaluation of Auto and/or General Liability Casualty Claims in the jurisdiction of NY and NJ.
• Respond to PIP Arbitration Proceedings.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of coverage, liability, and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts in the direction of the client.
• Document all correspondence, reports, discussions, and decisions in the claim file record.
• Provide outstanding service to the client.

Qualifications

• High School Diploma or GED required; bachelor’s degree in related field (preferred) and three years auto and general liability casualty related experience; or equivalent combination of advanced education and experience.
• At least three years of Automobile and General Liability claims experience required.
• Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge.
• Demonstrated verbal and written communications skills.
• Demonstrated advanced analytical, decision-making and negotiation skills.
• Computer proficiency.

Preferred Skills

• Ability to communicate effectively and clearly, both orally and in writing.
• Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
• Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.
• Excellent customer service skills.
• An understanding of the litigation process and case valuation in multiple jurisdictions.
• Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
• An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
• Time management skills, organizational skills, and ability to prioritize issues and tasks.
• Ability to effectively operate computer equipment and applications.
• Independence, flexibility, and creativity.

Other Qualifications

• Candidate must have a New York State Adjuster License.

Mental and Physical Requirements

• Mental Effort:
  • Follow one- or two-step instructions; routine, repetitive task.
  • Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
  • Follow written, verbal, or diagrammatic instructions; several concrete variables.
  • Solve practical problems; variety of variables with limited standardization; interpret instructions.
  • Logical or scientific thinking to solve problems; several abstract and concrete variables.
  • Wide range of intellectual and practical problems; comprehend most obscure concepts.
• Mathematical Development:
  • Simple addition and subtraction; copying figures, counting, and recording.
  • Add, subtract, multiply, and divide whole numbers.
  • Arithmetic calculations involving fractions, decimals, and percentages.
  • Arithmetic, algebraic, and geometric calculations.
  • Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
  • Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
• Language Development:
  • Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
  • Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
  • Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
  • Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
  • Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
• Physical Effort:
  • Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.
  • Near vision: clarity of vision at 20 inches or less.
  • Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet.