POSITION SUMMARY: The Commercial Auto & General Liability Claims Examiner III independently manages a complex caseload of high-exposure California public entity commercial automobile and general liability claims, including litigated, catastrophic, and highly sensitive matters. The position is responsible for analyzing coverage, liability, damages, and legal issues; developing claim-resolution strategies; directing litigation and investigations; establishing appropriate reserves; and negotiating settlements within assigned authority.
This senior-level examiner serves as a technical resource to clients, management, and less-experienced claims professionals. The position maintains frequent contact with claimants, attorneys, defense counsel, experts, public agency representatives, and other parties involved. The Claims Examiner III provides clients with comprehensive recommendations regarding exposure, litigation strategy, reserves, settlement, and claim resolution. Position is remote/working from home.
DUTIES AND RESPONSIBILITIES:
- Independently investigate, analyze, evaluate, negotiate, and resolve complex, high-exposure commercial automobile and general liability claims.
- Manage litigated, catastrophic, sensitive, and technically complex California public entity claims from initial assignment through final resolution.
- Review and interpret policies, contracts, endorsements, coverage documents, client service instructions, and applicable laws to determine coverage and claim-handling obligations.
- Apply California public entity laws, statutes, immunities, defenses, procedures, and claims-presentation requirements to assigned matters.
- Identify and analyze complex issues involving liability, causation, damage, comparative negligence, immunities, indemnification, contribution, and risk transfer.
- Develop and implement comprehensive claim-action plans, litigation strategies, reserve recommendations, and settlement strategies.
- Establish and maintain timely, accurate, and well-supported reserves within assigned authority; promptly communicate significant exposure changes to the client and management.
- Evaluate settlement value and negotiate complex claims within delegated settlement authority.
- Prepare and present settlement recommendations for claims exceeding assigned authority.
- Direct and oversee defense counsel, investigators, appraisers, medical experts, engineers, accident-reconstruction specialists, and other outside service providers.
- Review and evaluate litigation plans, legal budgets, pleadings, discovery, expert reports, deposition testimony, and defense counsel recommendations.
- Monitor litigation progress, legal expenses, deadlines, and defense counsel performance to ensure matters are handled efficiently and in accordance with client expectations.
- Participate in mediations, mandatory settlement conferences, depositions, trials, and other legal proceedings when required.
- Conduct or coordinate field investigations and site inspections involving complex or high-exposure losses.
- Attend city council meetings, claim-review meetings, litigation strategy meetings, and client presentations in person when required.
- Prepare comprehensive loss reports addressing coverage, liability, damages, reserves, litigation strategy, settlement value, and recommended next steps.
- Present complex claim evaluations and recommendations clearly and professionally to clients, public agency representatives, management, and other stakeholders.
- Identify potential subrogation, contribution, contractual indemnity, additional insured, tender, or other risk-transfer opportunities and pursue recovery or transfer efforts at the client’s direction.
- Identify potential excess coverage, reinsurance, Medicare reporting, liens, statutory reporting, or other significant claim-related obligations and ensure timely escalation.
- Maintain complete, accurate, and timely claim-file documentation, including correspondence, evaluations, reports, negotiations, decisions, and action plans.
- Maintain an effective diary system and ensure that all claim activities, statutory deadlines, litigation dates, and client reporting requirements are completed timely.
- Communicate significant developments, emerging exposure, coverage concerns, and recommended strategies promptly to the client and management.
- Ensure assigned claims are handled in compliance with company procedures, client service instructions, applicable laws and regulations, and industry best practices.
- Serve as a senior technical resource and provide guidance to less-experienced claims examiners regarding coverage, public entity law, investigation, litigation management, claim valuation, and negotiation.
- Assist with peer file reviews, complex claim roundtables, training, quality-assurance initiatives, and process improvements as requested.
- Identify claim trends, recurring legal issues, and potential areas of client exposure and communicate observations and recommendations to management.
- Provide exceptional and responsive service to clients and other stakeholders.
- Perform other duties and special projects as assigned.
