[Hiring] Professional Liability Claims Examiner III @Tristar Insurance

Role Description

Under the oversight of the Area Manager, the Claims Examiner III reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority and company guidelines. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules 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, process and conclude assigned claims including investigation and evaluation of professional liability claims.
• Review and interpret policies, coverage determination.
• 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 liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department with requested tasks or special projects.
• Other duties as assigned.

Position is remote/working from home.

Equipment Operated/Used

• Computer
• Other office equipment

Special Equipment or Clothing

• Appropriate office attire when on video or attending client meetings.

Qualifications

• Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
• Technical knowledge of coverage, statutory regulations, and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
• Ability to interact with people at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).
• Active Independent Adjuster New York State License.

Mental and Physical Requirements

• Mental Effort: Ability to follow one- or two-step instructions, solve practical problems; logical or scientific thinking to solve problems; ability to compose original correspondence.
• Physical Effort: Light work, exerting up to 20 pounds of force occasionally; requires sitting most of the time.
• Visual Requirements: Near vision, mid-range vision, depth perception, and color vision.
• Physical Activity: Frequent talking, hearing, and substantial movements of the wrists, hands, and/or fingers.

Working Conditions

• Disagreeable job conditions to which the employee may be exposed include dirt/dust, noise, temperature extremes, dampness, vibrations, and significant work pace/pressure.