Professional Liability Claims Examiner III
5 days ago
Atlanta
Fully Remote Atlanta Office - Atlanta, GA 30328 Overview: Salary Range $80,000.00 - $95,000.00 Salary/year Level Experienced Position Type Full Time Job Shift Day Education Level High School Diploma or GED Travel Percentage None Category Admin - Clerical POSITION SUMMARY: Responsible for the prompt review and interpretation of policy information, including all applicable endorsements and vehicle schedules, to determine coverage for loss, damage, or injury. Conduct thorough and efficient claim examinations and investigations leading to the final resolution of complex Commercial Automobile and General Liability casualty claims, including matters in litigation. The position requires frequent communication and interaction with insureds, claimants, attorneys, clients, experts, vendors, and other involved parties. Effectively communicate claim exposure, reserve recommendations, settlement strategies, and resolution plans to the client. This is a remote, work-from-home position. The employee must maintain a professional and secure work environment suitable for handling confidential company, client, and claimant information. DUTIES AND RESPONSIBILITIES: • Review, investigate, evaluate, negotiate, process, and resolve assigned complex Commercial Automobile and General Liability casualty claims., • Review and interpret policies, endorsements, vehicle schedules, and other relevant documentation to make appropriate coverage determinations., • Analyze coverage, liability, causation, damages, and potential exposure., • Oversee and direct outside service providers, including investigators, appraisers, experts, and other vendors., • Work closely with clients, client counsel, defense counsel, and investigative service providers to advance claims toward resolution., • Manage litigated claims, including evaluating litigation strategy, reviewing legal reports, monitoring discovery and trial activity, and assessing case value., • Maintain an accurate and timely diary system and complete all required follow-up activities., • Continually assess claim exposure and establish or recommend accurate reserves and settlement strategies., • Prepare comprehensive loss reports that include a thorough analysis of coverage, liability, damages, litigation status, exposure, reserves, and recommended next steps., • Identify potential subrogation, contribution, indemnification, or other risk-transfer opportunities and initiate recovery efforts at the direction of the client., • Accurately and timely document all correspondence, reports, discussions, evaluations, recommendations, and claim decisions in the claim file., • Independently manage a caseload of complex claims in accordance with company guidelines, client service instructions, applicable regulations, and industry best practices., • Provide timely, professional, and responsive service to clients and other involved parties., • Assist supervisors and the Claims Department with requested assignments and special projects., • Comply with all company policies and procedures., • Perform other duties as assigned. EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate business casual office attire QUALIFICATIONS REQUIRED: Education/Experience : High school diploma or GED required. Bachelor's degree in business, insurance, risk management, or a related field preferred. A minimum of seven years of progressively responsible experience handling complex Commercial Automobile and General Liability casualty claims is required. An equivalent combination of relevant education, training, and experience may be considered. Knowledge, Skills, and Abilities: • Seven to ten years of Commercial Automobile and General Liability claims-handling experience., • Advanced knowledge of claims-handling principles, practices, and procedures, including policy interpretation, coverage analysis, liability assessment, damage evaluation, reserving, negotiation, and settlement., • Demonstrated ability to independently manage complex, high-exposure, and litigated claims., • Strong understanding of the litigation process, litigation management, and case valuation across multiple jurisdictions., • Working knowledge of applicable statutory and regulatory requirements., • Knowledge of medical terminology and the ability to evaluate medical records, treatment, causation, and bodily injury damages, when applicable., • Advanced analytical, critical-thinking, problem-solving, decision-making, and negotiation skills., • Ability to evaluate complex information, exercise sound judgment, and make well-supported claim recommendations with minimal supervision., • Excellent verbal and written communication skills, including the ability to clearly communicate complex or technical information to clients, claimants, attorneys, and internal staff., • Ability to establish and maintain effective working relationships with individuals at all levels of the organization and with external business partners., • Excellent customer-service and relationship-management skills., • Ability to manage competing priorities and meet deadlines in a fast-paced environment., • Strong organizational, time-management, documentation, and follow-up skills., • Ability to understand and carry out detailed written and verbal instructions., • Ability to work independently while demonstrating sound judgment, flexibility, initiative, and creativity., • Proficiency with claims-management systems and standard business applications, including Microsoft Word, Excel, and Outlook. LICENSES AND OTHER REQUIREMENTS: • Must possess and maintain all adjuster licenses required to handle assigned claims., • Multi-state adjuster licensure is strongly preferred., • Must be able and willing to obtain additional licenses through designated-home-state reciprocity or applicable state adjuster examinations., • Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other relevant insurance designation preferred. MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORTa. Reasoning development:Follow one- or two-step instructions; routine, repetitive task.Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.Follow written, verbal, or diagrammatic instructions; several concrete variables.X Solve practical problems; variety of variables with limited standardization; interpret instructions.Logical or scientific thinking to solve problems; several abstract and concrete variables.Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development:Simple additional and subtraction; copying figures, counting, and recording.Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages.Arithmetic, algebraic, and geometric calculations.Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development:Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 1. PHYSICAL EFFORTa. Physical activity required to perform the job:Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.X Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds of force frequentlyc. Exerting a negligible amount of force constantly to move objects(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objectsHeavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objectsVery heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job:Far vision: