Professional Liability Claims Examiner, III

Job Description:

• Manage all aspects of Professional Liability claims from inception through resolution within established authority and company guidelines
• Review policy information, endorsements, and vehicle schedules to determine coverage for loss, damage, or injury
• Examine and investigate claims, including matters in litigation, through final resolution
• Interact frequently with claimants and their legal representatives
• Communicate recommendations regarding loss exposure, reserves, and settlement strategy to clients
• Review, process, and conclude assigned professional liability claims
• Interpret policies and make coverage determinations
• Oversee and direct outside investigative service providers
• Work with clients, client counsel, and investigative services to advance claims to conclusion
• Maintain an ongoing claim diary
• Assess exposure and evaluate reserves and settlement recommendations
• Prepare detailed Loss Reports analyzing liability and damages
• Determine and initiate subrogation or risk-transfer recovery efforts when applicable
• Document correspondence, reports, discussions, and decisions in claim files
• Provide outstanding client service
• Assist supervisors and the Claim Department with requested tasks or special projects
• Work remotely from home under the oversight of the Area Manager and reporting to the Claim Supervisor and/or Area Manager

Requirements:

• Bachelor’s degree in related field preferred; five (5) or more years related experience; or equivalent combination of education and experience
• Technical knowledge of coverage, statutory regulations, and medical terminology
• Analytical skills
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff
• Ability to interact with people at all levels in the business environment
• Ability to independently and effectively manage very complex claims
• Proficient in Word and Excel preferred
• Active Independent Adjuster New York State License
• High School Diploma or GED listed as the education level