Claims Examiner

The Role

Provides oversight of personal and commercial lines property claims, including review and approval of claims exceeding the TPA’s authority. Analyses coverage and ensures that appropriate coverage letters are sent by the TPA. Participates in audits of assigned TPAs and ongoing review of monthly reports. Works with underwriting to provide relevant information on claims, coverage and agents.

• Review claims submitted by TPAs and authorize reserves and payments where those amounts exceed the TPA’s authority
• Provide guidance to TPAs to ensure proper investigation and timely, equitable disposition of claims, including retention of experts and/or attorneys where needed
• Assist TPA with coverage analysis, seeking underwriting assistance where appropriate
• Review and approve reservation of rights and coverage denial letters to ensure accuracy and consistency in coverage analysis
• Review claims to ensure appropriate reserve levels and that changes are made on a timely basis
• Refer claims in excess of authority to supervisor
• Prepare notification to underwriters and reinsurers for large or contentious claims
• Review and approve TPA funding requests within authority
• Participate in claim file audits to monitor TPA performance
• Assist with preparation of reports for underwriting, agents, insureds or state agencies as needed
• Occasional travel
• Other duties as assigned

• Bachelor’s degree or the equivalent in related work experience; five or more years of progressive technical claim experience is required
• Thorough technical knowledge of commercial property claims practices and procedures; some D&F claim experience is preferred.
• Thorough technical knowledge of commercial property coverage forms; first party commercial auto knowledge a plus.
• Thorough functional knowledge of Microsoft Office tools, including Word and Excel
• Willingness to learn and handle other lines of business based on workload and need
• Self-starter with the desire to work in a collaborative environment and provide insight and feedback to other departments
• Detail-oriented service professional with the ability to communicate effectively with adjusters, co-workers and clients
• Strong analytical skills
• Strong verbal and written communication skills
• Good mathematical skills with ability to compute rate, ratio and percent and to draw and interpret bar graphs and tables.
• Strong attention to detail and focused on the delivery of high‑quality work
• Highly motivated, enthusiastic and structured working style
• Claims Evaluation
• Claims Negotiation
• Claims Strategy
• Communication
• Customer Relationship Management
• Local Market / Policy Knowledge
• Portfolio Management
• Reading Comprehension
• Third-Party Management
• TPA / DCA Management

Salary Range: $80,000 - $100,000