Job Summary

Analyzes coverage for increasingly complex claims submitted under the applicable policy form. 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 Team Lead, 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
• 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

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)