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Senior Claims Examiner

2 months ago

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 #127

Wednesday, August 7, 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 Claims Examiner l will manage a caseload of low to moderate severity/complexity property and casualty insurance claims under a moderate level of supervision, depending on level of experience. 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 Claims Examiner l will engage in verbal and written communication with claimants, attorneys, and policyholders. The Claims Examiner l will ensure that all state claims handling requirements are met and internal guidelines are followed. The Claims examiner l 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
  • Prepare correspondence to all required parties involved in claim when necessary
  • May investigate allegations and determine facts based on evidence and recorded interviews
  • May be required to complete actions to satisfy department of insurance and/or state regulations
  • 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
  • Maintain a high level of communication internally with claims management team and externally with insureds, claimants, and attorneys
  • May be called upon to assist in training existing and new Claims Examiners

Knowledge, Skills and Abilities

  • Excellent written and verbal communication skills
  • Strong analytical skills
  • Strong negotiation skills
  • Ability to work independently with moderate level of supervision
  • Excellent organizational skills
  • Proficiency in MS Office (Word, Excel, Outlook)
  • Ability to work in a team environment and take direction from Claims Manager
  • Ability to train and provide technical guidance to less experienced Claims Examiners
  • Functional knowledge and skills reflective of a fully competent Claims Examiner
  • 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
Other details
  • Job Family
    Claims
  • Job Sub Family
    Operations
  • Pay Type
    Salary


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