Senior Claims Examiner, Cyber

Senior Claims Examiner

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. 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 in existing business processes and assist in the implementation of new processes.

Ensure unit performs work thoroughly in a cost-efficient manner and at a high productivity level.

Business Controls and Policies

Comply with all corporate policies and procedures.

Report any breakdown in controls to management.

Conduct all activities in a safe manner.

Ensure all the above are followed within assigned work unit.

People Management

May plan, conduct, and supervise assignments. Train assigned personnel and assign work.

May assist with the review and evaluation of assigned personnel.

Education

Minimum 4 Year / Bachelors Degree in a related field, or the equivalent education and/or experience

Education, Licenses and Certifications Requirements

An active adjuster license is required in the state of residence or other designated home state, either at the time of hiring or at the latest, within six (6) months ("Grace Period") of beginning employment, and must be maintained as current at all times, including timely completion of continuing education requirements. Employees who begin employment without being licensed, must become licensed in their state of residence or alternatively, obtain a Texas adjuster license within the Grace Period. Timely obtaining adjuster licenses in additional states, which may require passing additional licensing exams, may be required based on business need.

Experience

6 Years relevant and progressive professional experience

Other

• Possess and have ability to apply knowledge of principles, practices, and procedures.
• Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
• Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word, Teams)

Working Conditions and Physical Demands

Additional Working Conditions and Physical Demands

• Work outside core business hours may be required to fulfill job responsibilities
• May require travel outside normal work location up to no more than 10%
• May require a valid driver's license
• May be required to remain stationary for extended periods of time
• May be required to move up to 10 pounds
• Must be able to operate a computer and other devices
• Close vision and ability to adjust focus, such as required to read a computer screen

Travel Requirements

Occasional travel (up to 10% of time)

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

HYBRID ROLE

REMOTE if the selected candidate does not reside near an office

California and New York Residents Only

For candidates working in person or remotely in the following locations, the reasonable pay range for this specific position is New York, NY & Encino, CA, $115,00 - $188,000 annually. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, gender identity, gender expression, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws. The salary range is the range TMHCC, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future, and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the pay range, the actual compensation will vary depending on the above factors as well as market and business considerations.