Key Facts

Remote From:

New York (USA) , Oregon (USA)

Category: Insurance Claims Examiner

Full time

Mid-level (2-5 years)

English

Hard Skills

Liability Insurance Litigation Management Loss Reserving Complaint Investigations Damage Assessments Risk Financing Underwriting Liability Law Vendor Management Patient Diary +5 more

Other Skills

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Communication
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Analytical Skills
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Time Management
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Teamwork
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Detail Oriented
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Social Skills
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Computer Literacy

Roles & Responsibilities

Experience reviewing and adjudicating complex commercial auto liability claims, including policy endorsements and vehicle schedules to determine coverage and liability
Ability to oversee and direct outside investigative service providers and collaborate with clients, client counsel, and investigative teams to advance claims
Proficiency in assessing exposure, establishing reserves, and making settlement recommendations
Strong documentation and communication skills, including maintaining claim diaries and preparing thorough loss reports for stakeholders

Requirements:

Review, process, and conclude assigned claims, including investigation and evaluation of complex commercial auto property and casualty claims with incurred losses up to $25,000
Oversee and direct outside investigative service providers; coordinate with the client, client counsel, and investigative services to move the claim to conclusion
Maintain an ongoing diary and monitor claim activity to ensure timeliness and accuracy of information
Prepare loss reports with thorough analysis of liability and damages; determine subrogation or risk transfer where applicable and initiate recovery efforts; document all correspondence, reports, discussions and decisions in the claim file

TRISTAR Insurance Group

Insurance

About TRISTAR Insurance Group

TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

SUMMARY: Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of DE PIP Claims, 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 Commercial Auto property and casualty claims with a total incurred of $25,000.
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 accurate reserves and settlement recommendation.
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.
Document all correspondence, reports, discussions and decisions in the claim file record.
Provide outstanding service to the client.
Assist Supervisors and Claim Department with requested tasks or special projects.
Other duties as assigned.