Sr. Claims Examiner - Commercial Liability - TechUSA

Position Summary:

The Senior Liability Claims Examiner provides prompt, courteous and fair claim service on homeowners and commercial general liability property damage, bodily injury, personal injury and medical payments claims from initial claim set up through claim resolution, including litigation.  This position will entail the handling of multi-jurisdiction personal homeowners' liability claims as well as commercial general liability, condominium and construction defect claims.

Duties and Responsibilities:

• Makes timely initial contact and appropriate follow up contact with all relevant parties to provide explanation of claim process, set expectations, gather facts and provide information on developments.
• Performs and documents initial coverage analysis and recognizes potential coverage issues
• Conducts, directs and/or oversees the development of facts necessary to address coverage, liability and damage aspects of the claim
• Evaluates facts to properly analyze applicable coverage issues
• Drafts coverage letters including declinations, reservation of rights, excess and partial denials
• Applies relevant jurisdictional laws and uses independent judgement to reach liability determinations based upon the facts
• Gathers appropriate supporting damage documentation and evaluates amounts owed for property damage/bodily injury/personal injury based upon analysis of coverage, liability, damage and relevant jurisdictional laws
• Effectively communicates claim decisions verbally and in writing to policyholders, claimants, attorneys and agents
• Properly updates claim file with key activities and documents
• Maintains effective diary system to bring claims to timely resolution
• Communicates effectively with internal business partners including Customer Service and Underwriting
• Develops constructive relationships and works effectively with outside vendors such as independent adjusters, coverage counsel and defense counsel
• Establish appropriate reserves based upon competent analysis of coverage, liability and damages and adjust reserves as necessary in a timely manner upon receipt of additional relevant information.
• Apply common sense and cost-benefit analysis to claim decisions
• Complete necessary claim reporting to management including high exposure alert notifications
• Develops and executes plan of action to resolve claims within scope of authority
• Conducts Medicaid/Medicare reporting in accordance with federal law
• Reviews invoices for accuracy and completes timely expense and indemnity disbursements assuring compliance with tax reporting requirements
• Oversees handling of cases in litigation and provides appropriate guidance to defense counsel
• Attends and actively participates in mediations and other forms of alternate dispute resolution where required by the court or where appropriate to move the claim to a timely and proper resolution
• Recognizes potential third-party tortfeasors and develops facts to support the likeliness of successful recovery
• Prepares appropriate claim updates for management and excess carriers
• Participates in claims reviews and roundtable discussions and presents issues and recommendations in a precise and understandable manner

 SKILLS AND ABILITIES:

• Exceptional customer service skills
• Emotional intelligence and ability to manage conflict
• Advanced analytical, problem-solving and decision-making skills
• Ability to communicate effectively verbally and in writing with varying audiences
• Excellent negotiation skills and track record of proven results
• Team-player who is comfortable working in a dynamic, entrepreneurial environment
• Willingness to simultaneously work on multiple projects and fulfill multiple roles
• Proven leadership and mentoring capabilities
• Ability to interpret a variety of policy forms and endorsements
• History of litigation claims management and working effectively with defense counsel
• Familiarity with reading and interpreting contracts, statutes and case law
• Strong computer skills and advanced knowledge of Microsoft products

QUALIFICATIONS:

• Bachelor's degree or higher
• 5 years liability claim handling experience (multi-jurisdiction and some condominium and commercial liability claim handling preferred) 
• 5 years bodily injury evaluation and negotiation experience (serious injury preferred)
• Licensed to adjust claims in Florida (multi-state licensing preferred)

All employees must pass a pre-employment background check.  Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position.  It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job.  Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.    

Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer.  We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

Position Summary:

The Senior Liability Claims Examiner provides prompt, courteous and fair claim service on homeowners and commercial general liability property damage, bodily injury, personal injury and medical payments claims from initial claim set up through claim resolution, including litigation.  This position will entail the handling of multi-jurisdiction personal homeowners' liability claims as well as commercial general liability, condominium and construction defect claims.

Duties and Responsibilities:

• Makes timely initial contact and appropriate follow up contact with all relevant parties to provide explanation of claim process, set expectations, gather facts and provide information on developments.
• Performs and documents initial coverage analysis and recognizes potential coverage issues
• Conducts, directs and/or oversees the development of facts necessary to address coverage, liability and damage aspects of the claim
• Evaluates facts to properly analyze applicable coverage issues
• Drafts coverage letters including declinations, reservation of rights, excess and partial denials
• Applies relevant jurisdictional laws and uses independent judgement to reach liability determinations based upon the facts
• Gathers appropriate supporting damage documentation and evaluates amounts owed for property damage/bodily injury/personal injury based upon analysis of coverage, liability, damage and relevant jurisdictional laws
• Effectively communicates claim decisions verbally and in writing to policyholders, claimants, attorneys and agents
• Properly updates claim file with key activities and documents
• Maintains effective diary system to bring claims to timely resolution
• Communicates effectively with internal business partners including Customer Service and Underwriting
• Develops constructive relationships and works effectively with outside vendors such as independent adjusters, coverage counsel and defense counsel
• Establish appropriate reserves based upon competent analysis of coverage, liability and damages and adjust reserves as necessary in a timely manner upon receipt of additional relevant information.
• Apply common sense and cost-benefit analysis to claim decisions
• Complete necessary claim reporting to management including high exposure alert notifications
• Develops and executes plan of action to resolve claims within scope of authority
• Conducts Medicaid/Medicare reporting in accordance with federal law
• Reviews invoices for accuracy and completes timely expense and indemnity disbursements assuring compliance with tax reporting requirements
• Oversees handling of cases in litigation and provides appropriate guidance to defense counsel
• Attends and actively participates in mediations and other forms of alternate dispute resolution where required by the court or where appropriate to move the claim to a timely and proper resolution
• Recognizes potential third-party tortfeasors and develops facts to support the likeliness of successful recovery
• Prepares appropriate claim updates for management and excess carriers
• Participates in claims reviews and roundtable discussions and presents issues and recommendations in a precise and understandable manner

 SKILLS AND ABILITIES:

• Exceptional customer service skills
• Emotional intelligence and ability to manage conflict
• Advanced analytical, problem-solving and decision-making skills
• Ability to communicate effectively verbally and in writing with varying audiences
• Excellent negotiation skills and track record of proven results
• Team-player who is comfortable working in a dynamic, entrepreneurial environment
• Willingness to simultaneously work on multiple projects and fulfill multiple roles
• Proven leadership and mentoring capabilities
• Ability to interpret a variety of policy forms and endorsements
• History of litigation claims management and working effectively with defense counsel
• Familiarity with reading and interpreting contracts, statutes and case law
• Strong computer skills and advanced knowledge of Microsoft products

QUALIFICATIONS:

• Bachelor's degree or higher
• 5 years liability claim handling experience
  • REQUIRED: CONSTRUCTION DEFECT CLAIM Mgmt / Processes
  • Preferred: Commercial liability claim handling preferred) 
• 5 years bodily injury evaluation and negotiation experience (serious injury preferred)
• Licensed to adjust claims in Florida (multi-state licensing preferred)

All employees must pass a pre-employment background check.  Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position.  It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job.  Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.    

Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer.  We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.