Senior Claims Examiner, Cyber

About TMHCC
Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Every policy we write is special, enabling our clients to do amazing things. From insuring the crops that feed us to the rock concerts that entertain us, to rescuing international travelers in trouble.
Organic growth and over 60 successful acquisitions have grown our 2023 Gross Written Premium (GWP) to over $7.5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.
What We Offer

• Competitive salary and employee benefit package
• Strong learning culture
• Growth perspectives
• 6% 401K match
• 20 days of PTO and 2 Floating Days
• Paid parental leave
• An opportunity to love what you do

Hybrid Work Schedule

Atlanta, GA | New York, NY | Encino, CA | Chicago, IL

or Remote  if the selected candidate does not reside near an office listed locations

Job Summary

Analyzes coverage for increasingly complex claims submitted under the applicable policy form. Accurately examines and processes claims for the business unit according to existing policies and contracts. Communicates with outside stakeholders, including reinsured clients, insureds, defense counsel, and/or coverage counsel. Possesses critical thinking and strong oral/written communication skills. As a Senior Claims Examiner, provides guidance and first-level claims examination and processing training, supervision and advice to less experienced claims staff. In collaboration with Claims Department Management, ensures compliance with Claims Department workflow and processes.

Key Responsibilities

Relying on broad experience and judgment, this role is responsible for accomplishing the following assignments and has substantial latitude for actions or decisions made with minimal review. These assignments are varied in nature.

• Review submitted claims for coverage and determine if a matter is covered under the applicable policy.

• Investigate increasingly complex claims and coverage issues.

• Draft actions plans, including coverage recommendations, and obtain requisite management approval for authority in excess of designated authority levels.

• Independently handle claims presenting limited exposure or straightforward coverage issues.

• Establish and revise claim reserves based on claim developments and counsel liability assessments within designated authority; seek management approval where needed.

• Draft coverage determination letters, including reservation of rights and denial letters.

• Appoint defense and/or coverage counsel, as appropriate.

• Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.

• Update claims diary as needed based on activity.

• Authorize settlements based on liability and other considerations within settlement authority provided by Claims Manager.

• Review, approve, and reimburse the Insured for legal, expert/vendor invoices, and settlement.

• Conduct detailed bill reviews to ensure appropriate payment.

• Maintain a claim file by accurately documenting all communications, activity, etc.

• Communicate with brokers or reinsured clients to obtain information necessary for processing claims.

• Attend mediations and arbitrations for reinsurance clients as needed.

• Train, mentor and assist other Claims staff in resolving claims issues, making lower-level decisions regarding claims disposition within departmental policies and procedures. Approve claims correspondence, requests for authority and claim payments within designated authority levels for less experienced claims staff.

• Assist in the management of the work flow of other members of the claims department.

• Maintain quality, quantity, and response time standards of the business unit and the Company.

Competencies

Planning

• Develop work plans, establish timelines, and set goals for assigned work and work unit.

• Assign resources as needed.

• Meet commitments on deadlines.

Communication

• Communicate team or work unit results and recommendations with management and clients as appropriate.

Cost Management

• Drive improvement