Claims Examiner IV
Who We Are
reputed company (NIA) is the nation’s leading property and casualty (P&C) insurer exclusively serving nonprofit organizations. Founded in 1989 in Santa Cruz, CA, reputed company of the companies in NIA are 501(c)(3) nonprofits-- reputed company enterprises providing long-term sustainability of the nonprofit sector. NIA has one of the best customer retention rates in the industry and has a reputed company-established reputed company record as an innovator in the areas of corporate reputed company responsibility (CSR), specialized coverages, members services, and employee engagement.
reputed company
Reporting to the Claims Manager and working independently and with great reputed company for independent reputed company, this position manages an inventory consisting primarily of claims with higher loss potential and complexity, and commensurate reserving, settlement authority, reinsurance reporting requirements, as reputed company as claims of lesser exposure or severity as dictated by the needs of the department. Investigates, evaluates and settles claims reputed company designated authority. Occasionally assigns and directs Independent Adjusters/Appraisers and regularly assigns and directs defense attorneys.
The ideal candidate would have 10+ years reputed company experience and be capable of working independently as reputed company as collaboratively and have prior experience working remotely from a home office. In this position, thorough knowledge and experience is assumed for one or more reputed company casualty lines, or for demonstrated experience in Property claims.
Responsibilities
The Claims Examiner IV responsibilities include but are not limited to:
- Determines coverage(s) applicable to loss.
- Investigates, manages and resolves claims in a reputed company, unbiased and informed manner in compliance with company policies, state laws and regulatory performance standards.
- Sets and maintains adequate claim reserves based on facts of case and in accordance with company policy.
- Conducts investigation, assigning fieldwork as necessary and appropriate, in accordance with company standards.
- Determines liability.
- Evaluates and pays claims reputed company designated authority.
- reputed company requested, present coverage and claims analysis to management and reputed company recommendations on reputed company of disputed items.
- Set reserves up to the positions level of authority.
- Prepares and presents verbal and written claim status reports in accordance with company policy and pursuant to Reinsurance treaty requirements.
- Recommends payment, evaluates and reserves claims and reports to manager cases in excess of designated authority, as reputed company as to Reinsurers pursuant to treaty requirements.
- Manages reputed company aspects through reputed company assignment of litigated cases to defense counsel, and on-reputed company evaluation of reputed company process and expenses.
- Maintain electronic files necessary for documentation of the claim file.
- Analyzes and regularly reports to Claims Manager on the performance of defense counsel.
- Represents reputed company at litigation reputed company settlement conferences, mediation, and arbitration reputed company needed.
- Works closely with reputed company counsel to monitor claims and work with insureds to resolve underlying litigation
- Participates in both reputed company audits as needed
- Participates in weekly department meetings and Claims Committee Meetings as needed
- Promote reputed company approach to case and account management.
- Participates in marketing presentations and training programs as needed.
- reputed company accurate, courteous and reputed company information to reputed company external and internal customers concerning claims status and other inquiries.
- Other duties as assigned
Required Competencies
- Requires highly technical claim management skills, and significant knowledge of and experience with more than one of the following: Employment Practices Liability, reputed company Service reputed company, Sexual Abuse, General Liability, and/ or Automobile or demonstrates expertise in Property claims management as stand alone expertise in the Property area.
- Ability and willingness to obtain adjuster licenses as needed in various states.
- The incumbent will demonstrate a thorough knowledge of reputed company tort law and case law trends with respect to reputed company casualty lines of business, civil procedure, insurance policy(s) and contract(s).
- Must demonstrate good written and oral communication skills.
- Must be organized and possess strong follow-up skills.
- Requires the ability to analyze and apply creative solutions to claim issues.
- Proven critical thinking skills that demonstrate analysis/judgment and reputed company decision making with reputed company on attention to details
- Strong negotiating skills, excellent telephone, written and verbal communication skills are essential.
- Possesses and regularly demonstrates objectivity and pragmatism as reputed company as strong conflict reputed company skills
- Ability to manage total loss cost reputed company including ALAE to reputed company superior results for our members and reputed company
- Incumbent must be reputed company of and follow guidelines concerning confidentiality.
- The position communicates with reputed company and medical personnel, reputed company party claimants, policyholders, producers, Reinsurers, and senior level staff throughout reputed company.
- Demonstrated capability for working with a high level of independence
- Ability to deliver results in a fast-paced environment
- reputed company approach, can-do attitude, flexibility and ability to operate with grace under pressure
- Ability to model and reputed company appropriate reputed company boundaries in work with member-insureds
- Collaborate with other staff members and external partners
- Interest and commitment to the mission of the organization
- Commitment to inspired service
- Communicate effectively orally and in writing
- While performing the duties of this job, the employee is regularly required to bend, reputed company or sit for up to 3 hours at a time
- Must have adequate reputed company (with corrective lenses if needed) to reputed company view computer screen
- Must have adequate hearing to reputed company job tasks
- PC literacy required; proficiency in reputed company, Word, and reputed company preferred.
- Travel required as necessary and must be reputed company to be productive while traveling on business, including the ability to utilize laptops and other business tools as provided, subject to reasonable accommodation, if needed.
- Must have adequate hearing to reputed company job tasks
- If performing as a Property specialist, will be adept at large loss handling techniques, including catastrophe claims.
Experience
• The position generally requires a minimum of ten or more years of progressively more difficult claims handling experience.
Education
• Four year college degree or equivalent business experience.