Professional Liability Claims Examiner III

Professional Liability Claims Examiner III

POSITION SUMMARY: Responsible for the prompt review of policy information including all relevant endorsements and schedules to determine coverage for loss and injury. Conduct an efficient claim examination and investigation leading to the final resolution of Professional Liability Claims including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

DUTIES AND RESPONSIBILITIES:

• Review, process and conclude assigned claims including investigation and evaluation complex Professional Liability – Errors and Omissions, D&O, complex General Liability as well as Nursing Home Professional Liability Casualty Claims.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate the same to ensure accurate reserves and settlement recommendations.
• Prepare Loss Reports providing thorough analysis of liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts, at the direction of the client and/or TRISTAR leadership.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department Leadership with requested tasks or special projects.
• Other duties as assigned

EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax/scanner machine and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING:     Appropriate office attire

Qualifications

Education/Experience:   Bachelor’s degree in related field (preferred) and a minimum of five+ (5-10) years Professional Liability and General Liability casualty related experience; or equivalent combination of advanced education and experience.

 Special Requirements:

• At least 5-10 years of Professional Liability and General Liability claims experience required
• Commercial Auto (complex exposure) experience is also desired
• Knowledge of claims handling concepts, practices and techniques, including but not limited to coverage issues and product line knowledge.
• State licensing required for all states with home state licensing and reciprocity available
• NY licensing or the ability to test for and obtain the license within 90 days from date of onboarding
• * Litigation, ADR and direct negotiations involved
• * Experienced communication skills, verbal and written
• * Service to internal and exterior customers and effectively maintaining working relationships
• * Able to work independently
• * Ability to evaluate for proper indemnity / expense reserves
• * Oversees development of legal billing and litigation reports for completion of LLRs [Large Loss Reports]
• * Participates in Claim Reviews and ADR hearings
• Demonstrated verbal and written communications skills.
• Demonstrated advanced analytical, decision making and negotiation skills.
• Computer proficiency.

Preferred Skills:

• Ability to communicate effectively and clearly, both orally and in writing.
• Ability to manage relationships in a fast paced environment, while demonstrating problem solving and decision making skills to work with customers.
• Good analytical abilities to review, exercise judgment and evaluate claims in order to make sound decisions with a minimal amount of supervision.
• Excellent customer service skills.
• An understanding of the litigation process and case valuation in multiple jurisdictions.
• Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
• An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
• Time management skills, organizational skills and ability to prioritize issues and tasks.
• Ability to effectively operate computer equipment and applications.
• Independence, flexibility and creativity.

Other Qualifications: 

• Multi state adjuster licensure and/or the ability to obtain licenses through home state reciprocity or through state adjuster examinations. AICPCU industry designations.