Claims Specialist

• Responsible for the resolution of moderate to high complexity ocean marine bodily injury and property damage claims
• Handle claims from coverage enquiry through legal liability assessment and quantum analysis
• Communicating developments and outcomes to all internal and external stakeholders
• Training and providing referral support for other team members
• Analyze coverage and communicates coverage positions
• Prepare coverage position letters
• Conduct investigations into loss facts and damages
• Initiating timely contact to appropriate parties throughout the claim's lifecycle
• Evaluating information on coverage, liability, and damage
• Negotiate and settle claims directly or indirectly
• Present at roundtables to senior claims leaders and underwriters

Senior Claims Examiner, Ocean Marine Claims

• Investigate and manage New York PIP/No-Fault claims from inception through closure.
• Review medical documentation, treatment plans, wage loss claims, and related expenses.
• Evaluate claim exposure and establish appropriate reserves.
• Coordinate with medical providers, attorneys, insureds, claimants, and vendors.
• Identify and address potential fraud indicators.
• Ensure compliance with New York No-Fault regulations, statutory timelines, and reporting requirements.
• Maintain accurate and timely claim documentation.
• Deliver exceptional customer service while effectively managing claim outcomes.

PIP Claims Adjuster

• The position of Care Advocate will play a leading role in developing an innovative digital product strategy based off your deep expertise and knowledge of the long-term care needs of the aging in your market.
• You will be part of a team delivering concierge services care-seekers and care-managers including but not limited to Caregiver support and Education.
• Conducting consultations with older adults and caregivers on aging services and supports providing support and guidance on the caregiving journey.
• Unlike other traditional Care Advocacy roles, your responsibilities will not stop there but will extend to working with digital product teams to help infuse your patient-centered knowledge into the design process and provide feedback that will help create incredible digital user experiences for millions of care-seekers and care-managers at a tremendous scale.
• This role will provide Subject Matter expertise on the local and state level programming and resources for aging adults and their caregivers.
• This role will provide education and resources to aging individuals seeking assistance with care options and navigating challenges.
• Intensive case management experience and crisis intervention.
• Approach problem-solving with a human-centered lens.
• Regular document key and frequent needs of users and report qualitative data (such as quotes and anecdotal stories that representative of user needs) and quantitative data (such as frequency of user needs and trends in gaps in local care environments and resources) to the digital product and design teams.
• Bring deep understanding of landscape and individual aging and long-term resources, facilities, organizations, agencies, and referral sources to help marketing team reach key partnerships and potential consumers who would benefit from our digital products.
• Report back to product and design teams opportunities for improvement of the digital products based off of user feedback.
• Review new product features before they are released to consumers to identify improvements or potential issues to proactively improve user experience.

Associate Claims Clinical, Care Advocacy

• Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level
• Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution
• Review and analyze supporting damage documentation
• Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions
• Establish appropriate loss and expense reserves with documented rationale
• Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines
• Communicate effectively and timely with internal (such as underwriting) and external customers on claims and account issues
• Maintain and manage diary system to efficiently manage and resolve assigned pending
• Identify and communicate trends with senior claims and underwriting management
• Effectively draft written communications to Insureds and Claimants regarding status of claim i.e. request for information, confirmation of investigatory details and/or coverage position letters
• Mitigate claim expenses as economically as possible
• Summarize claims in excess of authority and submit rationale to manager for approval
• Negotiate settlements within approved authority level, issue settlement payments and document all activities
• Identify potential subrogation and fraud opportunities and make appropriate referrals
• Support claims workflow efficiency by accurately documenting claim progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
• Use multiple systems to gather, enter and analyze claim metric data to ensure targets are achieved.

Senior DRC Claims Examiner

• Handle Sompo Casualty claims (primary and/or excess) and related systems and processes
• Provide technical oversight and guidance to TPA claim handlers and supervisors
• Adherence to client-specific claim handling guidelines, providing coverage and analytical analysis of potential exposures
• Manage counsel where assigned; develop and execute strategy to control expenses and resolve litigated claims
• Establish appropriate reserves; Analyze loss and expense trends on a portfolio of claims and assist in the development and implementation of plans to improve results
• Ensure that all claim information is reviewed and accurately and timely recorded; proactively manage correspondence and claim files and maintain a current diary in compliance with company standards
• Effectively represent the company’s interests in meetings and negotiations; maintain a high level of claim and industry related expertise in order to assure technical competency and communicate to team members regarding significant issues and relevant changes
• Support underwriters and actuaries during the renewal process, communicating with and supporting underwriting and other functional groups within the organization

Senior Technical Specialist – General Liability Claims

• Manage moderate to complex commercial claims involving bodily injury and property damage
• Independently investigate, evaluate, negotiate, and resolve third-party General Liability claims
• Serve as a technical resource, mentor, and trusted partner within the claims organization
• Support strong file quality, collaboration, and continuous improvement.

Senior Claims Representative – Specialty BI/GL

• Handle Commercial General Liability (CGL) and Business Owners Policy (BOP) claims from initial investigation through resolution
• Manage litigated and in-suit claims, partnering with defense counsel, experts and vendors throughout the litigation process
• Review policy language and determine coverage, liability, damages, and litigation strategy
• Develop and execute claim resolution plans that support timely and cost-effective outcomes
• Negotiate settlements with claimants, attorneys, and other involved parties
• Maintain accurate claim documentation in accordance with company and regulatory requirements
• Communicate with insureds, claimants, attorneys, vendors, and internal stakeholders

Complex Liability Adjuster – Litigated CGL, BOP Claims

• Proactively handle a cross-section of cyber claims on behalf of CFC from first notification of loss to settlement.
• Foster good relationships with policyholders, brokers and drive excellent customer service.
• Actively work with a panel of response vendors during claims incidents.
• Ensure that there is prompt and accurate reserving, identifying and pursuing relevant third party recoveries and seeking to reduce claims leakage.
• The ability to prioritise where necessary, identifying deadlines such as those stipulated within lawsuits, demand letters and in addressing claims queries.
• Work closely with CFC’s panel of service providers to ensure a quality and value for money service is provided/received within required timeframes.
• General claims administrative duties such as electronic file management filing and payment requests, and the production of management information.
• Working closely with underwriters providing feedback on claims issues/trends and the Products team concerning the development of CFC’s products and wordings.
• Identify and escalate claims related issues to line manager where necessary.

Claims Specialist – Cyber

• Actively managing commercial general liability claims for medium severity, and general liability, as well as the associated excess and umbrella policies
• Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel
• Develop and implement strategy relative to coverage issues
• Maintain contact with associated claims carrier(s)’ claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes
• Investigate claims and review the insureds' materials, pleadings, and other relevant documents
• 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
• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries.

Claims Examiner, Casualty

• Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies.
• Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively.
• Build and maintain customer relationships through timely and accurate policy service.
• Document and process loss information accurately to assess potential damages.
• Participate in quality control tasks, audits, risk assessments, and field reviews.
• Contribute to a positive work environment by demonstrating cultural expectations and influencing others positively.
• Support business objectives through quality control tasks, audits, and risk assessments.

Senior Claims Adjuster – Crop

• Manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage
• Handles litigated files and works with delegated authority
• Receives claims, confirms policy coverage and acknowledgment of the claim
• Determines validity and compensability of the claim
• Investigates claims and handles Auto and/or General Liability claims
• Establishes reserves and authorizes payments within reserving authority limits
• Communicates claim status with the customer, claimant, and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Collaborates with team members on more complex or problematic claims as necessary
• Additional duties as assigned

Senior Liability Claims Specialist

• Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
• Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
• Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols.
• Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
• Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
• Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
• Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
• Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
• Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
• Maintains compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations or trends for line of business.
• May serve as a mentor/coach to less experienced claim professionals
• May perform additional duties as assigned.

Complex Claims Specialist – Professional Liability, Real Estate

• Handle claims associated with GNY Custom book and other select accounts from inception to closure
• Assure that there are accurate reserve and expense controls implemented
• Focus on the early and fair disposition of cases
• Coordinate with defense counsel to prepare all cases for potential trial
• Assist underwriting and loss control in account reviews
• Interact with insured and broker as necessary

Custom Liability Claims Examiner

• To examine, adjust, defend, claims and lawsuits against our insureds
• Review and verify coverage for each claim, includes policy review and comparing to allegations made by the claimant
• Issue timely coverage position letters
• Conduct factual investigation directly or with the assistance of investigators
• Review and analyze various documents such as contracts, leases, condo/co-op governing documents, the insured’s business records, public records, medical records, property damage scopes, etc.
• Setting proper reserves timely; making a fair and prompt settlement determination
• Negotiate settlements
• Follow all company and departmental protocols
• Direct defense counsel, monitor/review discovery
• Maintain accurate and complete file notes
• Maintain current and meaningful diary system
• Participates in special projects and performs additional duties as required

Liability Claims Examiner

• Assess, prioritize, and route incoming claims communications based on urgency and complexity across the reinsurance claims team
• Setting up first notices of loss
• Communicate with brokers regarding reinsurance claims
• Adjust and process daily reinsurance claim activity across a variety of classes based on contract terms
• Examine new and existing reinsurance claims
• Evaluate actual and potential exposures, and recommend accurate and timely reserves and payments
• Collaborate with other functions across the company to provide periodic updates on reinsurance claim matters
• Prepare reports and communicate findings in regular claim meetings
• Update and maintain claim records within claims systems to ensure accuracy and completeness
• Determine coverage for straightforward claims by reviewing applicable policy terms and conditions
• Ensure compliance with internal corporate guidelines, processes and procedures
• Identify opportunities for process improvements within claims workflows

Junior Claims Analyst – Reinsurance

• Investigate, evaluate and settle more complex first and third-party commercial insurance property claims.
• Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
• Communicates with all relevant parties and documents communication as well as results of investigation.
• Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
• Travel is required to attend customer service calls, mediations, and other legal proceedings.

Claims Specialist – Professional Liability

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, including CEOs, claimants, providers' offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster – Northeast Jurisdictions

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, to include CEO's, claimants, providers offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster, Northeast Jurisdictions

• Independently analyze liability claim submissions for potential coverage
• Set adequate case reserves
• Promptly and professionally respond to inquiries from clients and their brokers
• Proactively drive early resolution of claims arising from General Liability products
• Manage a full pending of General Liability Claims
• Provide thought leadership in multiple forums within and outside the company
• Engage in business development, product innovation, and market/customer insight
• Develop strong working relationships with underwriting leadership

Complex Claims Specialist

• 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 customer commitments and deliverables are achieved
• Review and interpret medical records, utilizing resources as appropriate
• Complete 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
• Foster strong relationships with customers to understand their needs and ensure high levels of satisfaction

Claims Specialist jobs in New York

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