Professional Liability Claims Examiner, III
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Job Description
Professional Liability Claims Examiner III managing complex claims for an insurance organization. Reviewing coverage, investigating liability, and directing claims through resolution.
Responsibilities:
- Manage all aspects of Professional Liability claims from inception through resolution within established authority and company guidelines
- Review policy information, endorsements, and vehicle schedules to determine coverage for loss, damage, or injury
- Examine and investigate claims, including matters in litigation, through final resolution
- Interact frequently with claimants and their legal representatives
- Communicate recommendations regarding loss exposure, reserves, and settlement strategy to clients
- Review, process, and conclude assigned professional liability claims
- Interpret policies and make coverage determinations
- Oversee and direct outside investigative service providers
- Work with clients, client counsel, and investigative services to advance claims to conclusion
- Maintain an ongoing claim diary
- Assess exposure and evaluate reserves and settlement recommendations
- Prepare detailed Loss Reports analyzing liability and damages
- Determine and initiate subrogation or risk-transfer recovery efforts when applicable
- Document correspondence, reports, discussions, and decisions in claim files
- Provide outstanding client service
- Assist supervisors and the Claim Department with requested tasks or special projects
- Work remotely from home under the oversight of the Area Manager and reporting to the Claim Supervisor and/or Area Manager
Requirements:
- Bachelor’s degree in related field preferred; five (5) or more years related experience; or equivalent combination of education and experience
- Technical knowledge of coverage, statutory regulations, and medical terminology
- Analytical skills
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff
- Ability to interact with people at all levels in the business environment
- Ability to independently and effectively manage very complex claims
- Proficient in Word and Excel preferred
- Active Independent Adjuster New York State License
- High School Diploma or GED listed as the education level
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