Claims Specialist

• Manage an active desk of litigated and non-litigated claims of varying complexity under miscellaneous professional liability coverages
• Recognize exposures and ensure reserves are adequate and timely
• Evaluate coverage issues and identify risk transfer opportunities
• Manage litigation by proper expert selection, planning, budgeting and partnership with defense counsel
• Strong negotiation skills
• Effective communication both internally and externally
• Proactively manage claim resolution, including formation and implementation of resolution strategy, settlement valuation and obtaining settlement authority
• Actively participate in mediations as needed, within limit of settlement authority
• Manage allocated loss adjustment expense through strategic handling and bill review/payment processing in coordination with the billing unit
• Appropriately document claim files in accordance with established guidelines
• Maintain adjuster licenses, as required.
• This position may require occasional travel to attend mediations, trainings, trials and/or other related meetings.

Senior Professional Liability Claims Representative

• To analyze Auto Bodily Injury Litigation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Auto & Bodily Injury Litigation Claims Examiner – Commercial Auto

• To analyze complex or technically difficult bodily injury and general liability claims to determine benefits due.
• To work with high exposure claims involving litigation and rehabilitation.
• To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
• To identify subrogation of claims and negotiate settlements.
• Manages mid-level bodily injury and general liability claims by gathering information to determine liability exposure.

Claims Adjuster – Liability, Bodily Injury, General Liability, Multi State Jurisdiction

• Investigate and handle personal and commercial auto bodily injury claims of a complex and serious nature
• Perform special claims investigations and handle matters requiring broad technical claims knowledge
• Operate on an independent basis with little supervision
• Settle claims within assigned authority
• Maintain contact with attorneys concerning serious claim matters
• Review court decisions, law and coverage interpretations

Senior Claims Specialist – Auto Bodily Injury

• Analyzing liability claim submissions for potential coverage
• Setting adequate case reserves
• Promptly and professionally responding to inquiries from customers and their brokers
• Proactively driving early resolution of claims arising from the Cyber, Tech PL, Media and/or Crime professional liability lines of business
• Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses for tech E&O, first and third party cyber claims
• Strategizing and maximizing early resolution opportunities
• Monitoring litigation and managing local defense and breach counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves

Complex Claims Specialist – Cyber Tech E&O, Media & Crime

• Claims Management: Oversees end-to-end claims process. Responsible for active case management of Life claims. Ensures claims are processed accurately within regulatory and company guidelines. Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved. Review and interpret medical records, utilizing resources as appropriate. Complete complex financial calculations specific to claims when applicable. Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication. Apply contract/policy provisions to ensure accurate eligibility and liability decisions. Demonstrate and apply analytical and critical thinking skills.
• Client and Customer Relationships: Foster strong relationships with clients to understand their needs and ensure high levels of satisfaction. Addresses and resolves any customer challenges or concerns promptly. Communication via telephone, email, and text with employees, employers, attorneys, and others. Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards. Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities. Work independently as well as within a team structure. Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. Oversee the ongoing management of complex, high-priority or escalated cases and callers.

Senior Group Life Claims Examiner

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Liability Claims Adjuster – General Liability, Bodily Injury, Property Damage

• The Property Claims Representative will be responsible for handling a desk of first-party commercial property claims.
• Conduct investigations as they adjust 1st party property claims.
• Investigating losses to determine coverage and the extent of indemnity owed under the policy.
• Retaining and managing outside vendors and experts as part of a quality claims investigation.
• Obtaining and reviewing evidence, reports, and records.
• Establishing appropriate reserves, as warranted throughout the claims investigation.
• Processing expense and indemnity payments, as appropriate.
• Maintaining an organized and efficient workflow, including keeping an active diary on each open claim file.
• Providing superb customer service in a fast-paced environment.
• Drafting detailed correspondence, including coverage position letters and reservation of rights letters.

Senior Commercial Property Claims Representative

• Responsible for the resolution of high complexity and high exposure Workers Compensation claims in multiple jurisdictions
• Confirms coverage of claims by reviewing policies and documents submitted in support of claims
• Analyzes coverage and communicates coverage positions
• Conducts, coordinates, and directs investigation into loss facts and extent of damages
• Directs and monitors assignments to experts and outside counsel
• Evaluates information on coverage, compensability, and medical management to determine the extent of insured's exposure
• Sets reserves within authority or makes claim recommendations concerning reserve changes to manager
• Focus on driving claims to a resolution with a focus of returning the injured back to work
• Evaluate, Negotiate and settle claim when appropriate
• Prepares reports by collecting and summarizing information
• Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives
• Participates in special projects or assists other team members as requested
• Attend all state specific trainings as scheduled
• Travel to mediations, trials, and conferences as required

Claims Examiner III, Workers Compensation

• Handling Directors & Officers Liability Claims
• Identifying, investigating, and resolving coverage issues
• Providing clear communication of policy coverage issues to various stakeholders
• Coordinating with counsel and insureds
• Exploring technology and strategic claims resolutions
• Analyzing and budgeting litigation of claims
• Making presentations to management as necessary
• Managing reserve adjustments and payments

Claims Analyst IV – Management Liability

• Responsible for handling primarily Transportation/Logistics, Motor Truck Cargo, and other Inland Marine claims
• Handles moderate to complex exposure claims
• Confirms coverage of claims by reviewing policies and documents
• Directs and monitors assignments to experts and outside counsel
• Analyzes coverage and communicates coverage positions
• Prepares coverage position letters
• Conducts, coordinates, and directs investigation into loss facts and extent of damages
• Provides timely service throughout the life cycle of the claim by meeting service level agreements
• Evaluates information on coverage, liability, and damages
• Negotiates and settles claims
• Participates in special projects or assists other team members as requested
• Travels to mediations, trials, and conferences as required

Senior Claims Examiner, Inland Marine

• Responsible for the resolution of moderate complexity and moderate exposure first party property claims in multiple jurisdictions.
• Handles low to moderate low exposure claims.
• Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
• Analyzes coverage and communicates coverage positions.
• Ability to draft coverage position letters independently.
• Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.
• Conducts, coordinates, and directs investigation into loss facts and extent of damages.
• Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
• Sets reserves within authority or makes recommendations concerning reserve changes to manager.
• Utilizes diary system to pro-actively resolve outstanding issues and to ensure timely processing and closure of the claim.
• Negotiates and settles claims directly with claimant.
• Prepares reports by collecting and summarizing information.
• Participates in special projects or assists other team members as requested.
• Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.
• Identifies subrogation opportunities and fraud potential and makes appropriate referrals.

Claims Examiner II

• Make initial contacts with interest parties
• Handle moderate to high exposure construction defect claims involving residential and commercial projects.
• Analyze coverage and draft coverage position letters as needed
• Conduct liability investigations
• Comply with DOI regulations
• Retain and coordinate with defense counsel and experts to develop and execute agreed-upon litigation strategies, while managing plans and budgets to ensure effective case resolution
• Coordinate the retention of experts, subject to an agreed upon budget
• Establish timely indemnity and expense reserves based on an exposure analysis that is documented in the claim file, revisiting reserve adequacy on a continual basis
• Draft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners
• Travel up to 10% to attend mediations, settlements conferences and trials on appropriate cases
• Keep current on key changes in case law and industry trends
• Assist underwriting and other business partners

Senior Casualty Claims Examiner – Construction

• Analyze Workers Compensation claims to determine benefits due.
• Manage complex workers’ compensation claims from initial investigation through final resolution.
• Evaluate claim exposure and develop action plans.
• Negotiate settlements and ensure compliance with guidelines.
• Establish and maintain accurate reserves throughout the life of each claim.
• Compute and issue benefit payments, adjustments, and settlements timely.
• Prepare and submit required state filings within deadlines.
• Oversee litigation and partner with vendors.
• Communicate with claimants and clients frequently.

Claims Examiner – Workers Compensation

• Investigate, negotiate and settle complex primary and excess policy casualty claims including negligence, premise liability, commercial automobile, construction bodily injury, construction defect, product liability, and sexual assault
• Investigate and analyze coverage under primary and excess casualty insurance policies; make coverage determinations; draft routine and complex coverage correspondence; effectively communicate coverage positions to policyholders and other stakeholders; manage claims involving coverage litigation
• Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist internal business partners, including claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues
• Communicate with underwriting as needed to manage claims and to alert of any significant developments
• Promptly communicate with management on adverse case developments and provide information on pertinent issues affecting professional liability product lines
• Proven ability to work in a collaborative team environment
• Analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form
• Maintain and adhere to internal guidelines and procedures
• Ensure proper adherence to internal reporting requirements
• Contribute and assist in the implementation of a wide range of initiatives, discussion and action plans brought forth by management
• Participate in agent related functions and meetings as required
• Actively participate in the ongoing training and development of the claims examiners

Executive Claims Examiner

• To analyze Medical Only & Lost-Times Workers Compensation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution.
• Investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Workers' Compensation Claims Adjuster

• To analyze Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due.
• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims.
• Develops and coordinates low level workers compensation claims' action plans to resolution.
• Communicates claim action with claimant and client.
• Maintains professional client relationships.

Workers Compensation Claims Representative, NY Jurisdictional Experience

• Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis
• Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care
• Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures
• Maintain contact with any/all associated claims carrier(s)’ claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary
• Investigate claims and review the insureds' materials, pleadings, and other relevant documents
• Identify and review each jurisdiction's applicable statutes, rules, and case law
• Review litigation materials including depositions and expert's reports
• Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues
• Retain counsel when necessary and direct counsel in accordance with resolution strategy
• Analyze coverage, liability and damages for purposes of assessing and recommending reserves
• Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves
• Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter
• Negotiate resolution of claims
• Select and utilize structure brokers
• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims

Claims Examiner, General Liability

• Investigates origin and cause of high exposure claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel, etc.
• Checks for prior claims and recognizes environmental exposures.
• Participates in High Damage Reviews (HDR) to address coverage issues and exposure.
• Handles claims on a good faith basis.
• Handles both 1st party and 3rd party claims under multiple policy types and numerous endorsements.
• Conducts on-site inspections when needed, evaluates damages and handles claim negotiations with insureds, claimants, attorneys, public adjusters.
• Interprets and determines policies, leases, by-laws, declarations, articles, and contract coverages and applies to all parties for assigned losses.
• Proactively provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
• Serves as a mentor and subject matter expert for less experienced adjusters.

Large Loss Property Field Claims Adjuster

• keying, processing health claims in accordance with claims policies and procedures
• able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology
• adjust claims
• reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement
• researches and analyzes claims issues
• responds to inquiries, may involve customer/client contact

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