Claims Examiner

Manages complex, high-value claim and suit files independently. Cases will involve complex coverage, liability, damages and/or injuries. May give technical assistance to staff adjusters. Manages independent adjusters and attorneys assigned to the Examiner’s files. Has settlement authority in excess of adjusters. May extend settlement authority to staff adjusters. Does not administratively supervise staff adjusters.

Essential Duties and Responsibilities:

• Analyze, review, and interpret policies to resolve coverage and assess liability.
• Independently handle more complex and high-exposure Commercial General Liability claims, including claims in litigation and construction defect claims.
• Under general supervision and direction, resolves complex claims by investigating losses, negotiating settlements, presenting evidence in legal proceedings while maintaining adequate production and quality levels.
• Investigates claims by interviewing shipper, consignee, witnesses, requesting and obtaining official reports, requesting, and reviewing survey reports, and comparing claim information with evidence.
• Independently manage files in litigation.
• Establish and maintain proper loss and expense reserves.
• Determine what investigation is necessary to bring a claim to an equitable conclusion for all parties involved.
• Properly document information in the claim file.
• Review insurance policies for coverage and make recommendations.
• Make decisions regarding the liability of an insured.
• Maintain a working diary of assigned claims.

Required Education/Experience:

Basic

• A four-year degree from an accredited institution or equivalent experience.
• Knowledge of and adherence to the state laws and regulations governing the handling of property and casualty claims.
• A minimum of 3 years of successful handling of general liability claims in litigation, preferably including construction defect claims.
• A basic understanding of accounting principles, construction, underwriting, marketing, and auto physical damage estimating.

Advanced

• Seven plus years successful handling of claims including advanced skills in coverage, investigation, litigation, negotiation, salvage, and subrogation.
• Knowledge of medical terms and legal issues.
• Excellent computer skills.
• Advanced communication skills are required to understand, interpret, and convey technical information.
• Excellent time management skills
• Experience handling construction defect litigation a plus.

Licensing:

• A valid resident adjuster license for the license state of the applicant.
• A non-resident adjuster’s license where required in the states where we do business