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Senior Claims Examiner

4 months ago

Philadelphia, United States Septa Full time
Secure your FUTURE with SEPTA today

The Southeastern Pennsylvania Transportation Authority (SEPTA) is the sixth largest transportation system in the United States, with a vast network of fixed route services including bus, subway/elevated, trackless trolley, light rail, and commuter rail serving a 2,200 square mile service region. SEPTA has become an integral force in the economic success of the Philadelphia region, providing an efficient and reliable source of transportation.

We are seeking candidates for the position of Senior Claims Examiner (9133) in the Legal - Video, Intake and Claims.

Opening Date: 06/12/2024

Closing Date: 06/26/2024

Job Grade: SAM 40

Salary Range: Min: $79,534.00 - Mid: $99,424.00 - Max: $119,314.00

OVERALL DESCRIPTION

Manages Office of General Counsel (OGC) resources and collaborates with others to ensure that required information to properly manage claims is part of claims file. Investigates and evaluates tort liability claims, working with team of OGC professionals, outside counsel and experts to categorize, reserve and strategize claim resolution toward planned resolution.

SPECIFIC RESPONSIBILITIES

  • Primary responsibility for managing a large inventory of liability claims from first notice of claim through final resolution.
  • Collaborates with Intake/Intel professionals to ensure that all assigned liability claims files contain the information required to properly and completely investigate and evaluate claims.
  • Identifies and evaluates coverage issues.
  • Conducts, coordinates, and directs investigation into loss facts and extent of third party damage.
  • Manages reserves adequacy throughout the life of the claim. Alerts upper management of cases with high exposure, legal changes, and jurisdictional value. Professionally presents cases to senior leadership for those of significant value.
  • Prepares detailed and comprehensive initial reports and follow up reports with concise and effective action plans designed to move the claim towards resolution.
  • Collaborates with defense counsel and management team to facilitate positive claim resolution.
  • Manages outside litigated claims by developing litigation plan with outside counsel and ensure service requirements are met; Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed; Tracks and controls legal expenses to assure cost-effective resolution.
  • Documents and communicates all claim activity timely and effectively, and in a manner that facilitates a fair and appropriate outcome.
  • Settles claims consistent with planned resolution and in accordance with authority.
ADDL / DISCIPLINE RESPONSIBILITIES
  • Analyzes and evaluates medical records, diagnostic testing, and medical bills to determine if injuries and treatment are causally related. Completes and submits authority request report. Negotiates and settles claims with claimant’s counsel and unrepresented claimants within provided authority.
  • Identifies potential suspicious claims and refers to the Office of the Inspector General. Identify opportunities to tender the claim to third party vendors by reviewing contracts/certificate of insurance.
  • Coordinates with property damage unit to identify and pursue recovery/subrogation potential.
  • Manages the litigation process for outside counsel and adhere to litigation guidelines to include budget, bill review and payment. Attends settlement conferences, court hearings, arbitrations and trial as required.
  • Provides outstanding customer service and with internal and external customers in the adjustment of the claims.
  • Handles claims consistent with SEPTA policies, procedures and "best practices" and also, in accordance with any statutory, regulatory and ethics requirements.
  • Performs other duties as required/assigned.
QUALIFICATIONS AND EXPERIENCE
  • Bachelor's Degree from an accredited college/university required plus five (5) years of experience handling General Liability claims required which includes a minimum of two (2) years of handling complex and litigated claims.
  • An equivalent combination of experience and education (i.e., two (2) years of related experience, equating to one (1) year of formal post high school education) may be considered in lieu of the above requirements.
  • Knowledge of PA Motor Vehicle Financial Responsibility Law and PA Tort Law and PA Rules of Civil Procedure required.
  • Excellent written, verbal and interpersonal skills required.
  • Personal Computer experience including knowledge of Microsoft Outlook, Word and Excel is required.
  • Excellent customer focus to proactively identify and understand customer needs required.
  • Demonstrated decision-making skills, including the ability to recognize, analyze and improve claims' management practices required.
  • Ability to think critically, identify and solve problems, plan and organize activities and negotiate effectively required.
BENEFITS

SEPTA offers a comprehensive benefits and retirement program:
  • Medical - Minimal annual premium contribution
Benefit plans with No Employee annual premium contribution:
  • Prescription
  • Dental
  • Vision
Additional benefits we offer:
  • Defined Benefit Pension Plan
  • Voluntary Governmental 457B Deferred Comp Plan, with available Financial Advice and Planning Services
  • Life Insurance
  • Paid Parental Leave
  • Tuition Reimbursement
  • SEPTA Transportation Pass - FREE travel on all SEPTA modes of transportation
  • SEPTA employees qualify for the Public Service Loan Forgiveness (PSLF) program
  • Generous Vacation Allowance
  • Dependent Care Flexible Spending Account


SEPTA is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Nearest Major Market: Philadelphia