Senior Claims Examiner

1 month ago


Richmond, United States James River Management Company Full time


Senior Claims Examiner - Claims Specialist - Construction Defect

Alpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual
Req #118

Tuesday, June 25, 2024

Come grow with James River Insurance

James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.

At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2023, 2022, and 2021 Top Workplaces USA awards.

James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.

Job Summary

The Senior Claims Examiner will manage a caseload of insurance claims pending under a moderate to low level of supervision. Job functions include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of insured's or insurer's liability; Reviewing and evaluating damages and determining strategies for resolution. Settling claims in accordance with policy provisions and within an authority level. The Sr. Claims Examiner will engage in verbal and written communication with brokers, claimants and policyholders. The Sr. Claims Examiner will ensure that all state claims handling requirements are met and internal guidelines are followed. The Sr. Claims examiner will handle claims in accordance with established James River Claims Best Practices.

Duties and Responsibilities

  • Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
  • Perform coverage, liability, and damage analysis on all claims assignments
  • Investigate allegations and determine facts based on evidence and interviews
  • Draft disclaimers and reservation of rights letters when coverage issues arise
  • Assign limited investigations and appraisals to licensed insurance professionals
  • Negotiate settlements, mitigate losses, and control expenses
  • Manage litigated files in accordance with Litigation Management Guidelines
  • Provide technical guidance, assistance and training to co-workers
  • Maintain a high level of communication internally with Claims Management team and externally with Insureds, claimants, attorneys and brokers.
  • Frequently called upon to train new Claims Examiners
  • Will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims

Knowledge, Skills and Abilities

  • Excellent written and verbal communication skills
  • Strong analytical skills
  • Strong negotiation skills
  • Excellent organizational skills
  • Proficiency in MS Office (Word, Excel, Outlook)
  • Ability to take direction from Claims Manager
  • Ability to work independently with limited supervision
  • Ability to work on assignments that require a higher technical level of expertise due to complexity and exposure, under minimal supervision
  • Ability to work successfully as an individual contributor and in a team environment
  • Recognized as having a high level of expertise in claim handling and suit management
  • Ability to provide technical guidance and assistance, and train less experienced Claims Examiners
  • Possess demonstrated technical knowledge and skills, including product and industry, reflective of successful progress
  • Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter.

Experience and Education

Senior Claims Examiner

  • High school diploma required
  • College degree preferred
  • Minimum of five years P&C claims handling experience
  • Experience and proven track record in managing complex coverage issues and complex litigation
  • Multi-jurisdictional claims experience
  • Adjuster license and/or certifications preferred

Claims Specialist

  • High school diploma required
  • College degree preferred
  • Advanced degree or law degree preferred
  • Minimum of seven years claims handling experience
  • Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
  • Experience working with complex coverage issues
  • Multi-jurisdictional claims and litigation experience
  • Adjuster license and/or certifications desired preferred
#LI-KS1

#LI-Remote

Other details
  • Job Family
    Claims
  • Job Sub Family
    Operations
  • Pay Type
    Salary


Apply Now

Share this job:

  • Richmond, United States James River Management Company Full time

    Senior Claims Examiner - Claims Specialist Alpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual Req #127Wednesday, August 7, 2024Come grow with James River Insurance! James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50...

  • Claims Examiner

    2 weeks ago


    Richmond, United States Kinsale Insurance Company Full time

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting...

  • Examiner, Claims

    2 weeks ago


    Richmond, United States Molina Healthcare Full time

    JOB DESCRIPTION Job Summary Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. KNOWLEDGE/SKILLS/ABILITIES Evaluates the adjudication of claims using standard principles and state...

  • Claims Examiner

    2 months ago


    Richmond, United States Kinsale Insurance Company Full time

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting...

  • Claims Examiner

    6 days ago


    Richmond, United States Kinsale Insurance Company Full time

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting...


  • Richmond, United States Kinsale Insurance Company Full time

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting...


  • Richmond, United States Kinsale Insurance Company Full time

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting...


  • Richmond, Virginia, United States Commonwealth of Virginia Full time

    Position Overview The Commonwealth of Virginia is seeking a Senior Claims Analyst to join our dedicated team. This role involves the thorough examination of correspondence, medical documentation, claims, electronically transmitted data, and various forms to ensure effective follow-up until all issues are satisfactorily resolved. Each interaction must be...


  • Richmond, United States Medical Mutual Liability Insurance Soc. of MD Full time

    Senior Medical Malpractice Claims RepresentativeJob DescriptionMedical Mutual Liability Insurance is seeking an experienced, highly-motivated professional to join our ProAd subsidiary division as a Senior Medical Malpractice Claims Representative. This is a full-time, hybrid position based out of our Richmond, Virginia office. In this exciting role on our...

  • Subrogation Examiner

    2 weeks ago


    Richmond, United States Elevance Health Full time

    Job Description : Subrogation Examiner Location: Virtual but the ideal candidate will live within 50 miles of our Indianapolis, IN, Waukesha, WI, or Louisville, KY Elevance Health PulsePoint locations. A proud member of the Elevance Health family of companies, Carelon Subrogation, formerly Meridian Resource Company, is a health care cost...


  • Richmond, Virginia, United States Commonwealth of Virginia Full time

    Position OverviewThe Commonwealth of Virginia is seeking a Senior Analyst for Claims Services to join our dedicated team. This role involves the thorough examination of various documents, including correspondence, medical records, and claims data, to ensure efficient follow-up until all issues are resolved. The selected candidate will meticulously document...


  • Richmond, Virginia, United States Commonwealth of Virginia Full time

    Job Responsibilities The Commonwealth of Virginia is seeking a Senior Claims Analysis Specialist to meticulously evaluate correspondence, medical documentation, claims, electronically transmitted data, agreement forms, and various other records to ensure thorough follow-up until all issues are resolved. This role requires precise documentation of each...


  • Richmond, Virginia, United States Commonwealth of Virginia Full time

    OverviewSupported by the Office of the Senior Vice President for Health Sciences (OSVPHS), the Division for Academic Success (DAS) at the Commonwealth of Virginia is dedicated to creating inclusive and accessible educational environments. Our mission is to enhance academic achievement through innovative services and programs in partnership with faculty,...


  • Richmond, United States Genworth Full time

    At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care—and we bring those experiences with us to...

  • Driver

    1 week ago


    Richmond, United States Erickson Senior Living Full time

    Location: Avery Point by Erickson Senior Living Avery Point is a beautiful 94-acre continuing care retirement community located just 15 minutes from downtown Richmond in Short Pump, Virginia. We're part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with campuses in 11...

  • Driver

    1 week ago


    Richmond, United States Erickson Senior Living Full time

    Location: Avery Point by Erickson Senior Living Avery Point is a beautiful 94-acre continuing care retirement community located just 15 minutes from downtown Richmond in Short Pump, Virginia. We're part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with campuses in 11...


  • Richmond, United States Gallagher Full time

    Introduction: Discover a world of endless possibilities at Gallagher Benefit Services, where you'll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock...


  • Richmond, Virginia, United States Bon Secours Mercy Health Full time

    Join Our Team as a Senior Cardiac Ultrasound SpecialistCompany Overview:At Bon Secours Mercy Health, we are committed to enhancing the quality, safety, and cost-effectiveness of healthcare services. Our facilities and healthcare professionals are recognized for their excellence in clinical and operational practices.Position Summary:The Senior Cardiac...


  • Richmond, United States Universal Health Services Full time

    Responsibilities One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was...


  • Richmond, Virginia, United States Bon Secours Mercy Health Full time

    At Bon Secours Mercy Health, we are committed to enhancing the quality, safety, and cost-effectiveness of healthcare services. Our facilities and healthcare professionals are recognized for their excellence in clinical and operational practices.Job Title: Senior Cardiac Ultrasound SpecialistPosition Overview:The Senior Cardiac Ultrasound Specialist is...