Claims Examiner
Core Specialty Insurance Services, Inc.
Adjust and manage claims brought against security companies, private investigators and alarm installation and monitoring companies, from receipt of claim or suit through resolution or trial or appeal. Key Accountabilities and Deliverables Provide early contact with insured to identify witnesses, employees, contracts, other relevant documents and obtain insured’s knowledge of the allegations in the claim or suit. Analyze coverage for application to claim and prepare coverage position letters including reservation of rights, DISCLAIMERS, tender to other parties and acceptance of tenders to insured where appropriate. Confer with internal and external coverage counsel to clarify coverage position and coverage litigation. Communicate with underwriting regarding insured’s risk potential and clarification of policy language intent. Maintain diaries for file tasks, settlement conferences, mediations and trial. Oversee defense counsel from initial assignment of defense and throughout litigation to ensure timely reporting, confirmation of defense strategy and analysis of new developments. Collaborate with defense counsel to develop early litigation or settlement strategy. Ensure that Defense Counsel provides timely pre‑trial reports. Maintain claim files, notes and documentation that comply with internal guidelines and external regulations, including analysis of liability, damages, adequacy of reserves and outline of plan or next steps. Prepare internal reports for file documentation and early identification of significant reserve increases for presentation to management and upper management for review. Communicate with manager regarding critical new developments, significant reserve increase recommendations, and potential settlement recommendations above handler’s settlement authority. Provide timely communication and reporting of critical or new developments to exterior carriers including coverage, litigation developments, reserves and potential settlement opportunities. Review and approve litigation budgets submitted by Defense Counsel. Regularly review and update claim files that remain open but currently inactive and are not generating claim activity. Evaluate inactive claims for closure and removal of reserves. Attend mediation and settlement conferences when required to facilitate and negotiate settlement. Monitor and approve or reject litigation expenses recommended by Defense Counsel. Prepare settlement drafts and review releases for accuracy. Travel occasionally for matters that cannot be handled through video conference. Technical Knowledge and Understanding Licenses to be obtained where required by a state to adjust claims within that state. Knowledge of third‑party liability claims handling is required. Knowledge of first‑party commercial auto claims handling is preferred. Experience and Education Bachelor’s degree required. 3 or more years of claims experience preferred. Law degree is a plus. Previous experience in a similar role. Eligibility Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over work authorization sponsorship now or in the future for this position. Benefits Medical, dental, vision and life insurances; short‑ and long‑term disability; a Company‑match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account and a wellness program. #J-18808-Ljbffr
$300k
...Overview Examines, investigates and evaluates information from policyholders, attorneys, physicians, hospital personnel, police departments... ...the disposition of life, annuity, health and disability claims within authority limits. Benefit and coverage decisions made are...SuggestedPermanent employmentContract workWork experience placementWork at office- As the Healthcare Claims Examiner, you will directly handle Commercial Healthcare Claims across the U.S. Key Accountabilities / Deliverables Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation,...SuggestedTemporary workWork at officeFlexible hours
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