Claims Examiner - Liability

Primary Purpose:
To manage and resolve complex or high-exposure general liability claims, including those involving litigation and rehabilitation. This role ensures claims are adjudicated in accordance with service expectations, industry best practices, and client-specific requirements. The analyst also identifies subrogation opportunities and negotiates settlements.

Key Responsibilities

• Investigate and analyze complex general liability claims to determine exposure and develop resolution strategies.
• Assess liability and negotiate settlements within designated authority.
• Establish and maintain appropriate reserves; ensure reserve adequacy throughout the claim lifecycle.
• Approve and process timely claim payments and adjustments.
• Prepare and submit required state filings within statutory deadlines.
• Manage litigation processes to ensure timely and cost-effective resolution.
• Coordinate with vendors for investigations and litigation support.
• Utilize cost containment strategies to reduce overall claim costs.
• Handle claim recoveries, including subrogation, Second Injury Fund, and Medicare/Social Security offsets.
• Report claims to excess carriers and respond to their inquiries.
• Maintain professional communication with claimants and clients.
• Ensure accurate documentation and coding of claim files.
• Refer complex cases to supervisors or management as needed.
• Support organizational quality programs.
• Travel as required.

Work Environment & Requirements

• Mental: Strong analytical thinking, judgment, and problem-solving skills. Ability to manage multiple priorities and meet deadlines.
• Physical: Frequent computer use; travel as needed.
• Auditory/Visual: Clear communication, hearing, and vision required.
• Security: Credit background check required.

Qualifications

Education & Licensing:

• Bachelor’s degree preferred.
• Professional certifications relevant to general liability claims are a plus.

Experience:

• Minimum of 5 years of claims management experience, or an equivalent combination of education and experience.

Skills & Knowledge:

• In-depth knowledge of insurance principles, laws, and claims processes.
• Strong negotiation, communication, and interpersonal skills.
• Proficiency in Microsoft Office and claims management systems.
• Excellent organizational and analytical abilities.
• Ability to work independently and collaboratively in a team environment.
• Commitment to meeting or exceeding service expectations.