Claims Examiner - General Liability

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Claims Examiner - General Liability

PRIMARY PURPOSE: To act as a department subject matter expert by providing guidance to the complex claims team to ensure consistency resolving matters optimally while creating a culture of continual quality improvement destined to elevate the overall claim handling to benefit our stakeholders; to ensure the consistency in the developed targeted solutions, and technical guidance and oversight provided to claims team.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Proactively and strategically manages a complex claim inventory by assessing highly complex claims issues, utilizing jurisdictional expertise, providing oversight, and helping direct the handling to achieve the best possible resolution
• Assesses liability and resolves claims within evaluation.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Receive and review relevant pleadings, medical records and other investigative documents.
• Review and evaluate insurance contract wording and coverage for each assigned claim.
• Discuss claim with appointed panel counsel and establish a comprehensive investigative and litigation management strategy for each claim;
• Manage claims within preexisting litigation protocols and practices;

• Assists the claims team as their subject matter expert to assist in addition to lines of business and key jurisdictions on complex claim issues.
• Articulates and documents clear and concise file notes to allow stakeholders to understand the issues and path to resolution.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travel may be required but would be limited to attending mediations or trials.

Education & Licensing

• J.D. preferred, but not required
• Bachelor's degree from an accredited college or university preferred. Industry designation(s) preferred. Licenses as required for specific jurisdictions.

Experience

• 10+ years of experience of claim experience litigating commercial exposure.

Skills & Knowledge

• Knowledge of California Laws
• California Claims experience
• Experience in reading and int