Claims Examiner

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Direct handling of E&O claims to ensure that matters are handled efficiently and that incoming cases, inquiries, incidents are timely prioritized and resolved while maintaining high quality customer service.

Key Accountabilities/Deliverables:

Initial Claim Assessment: Quickly evaluate and prioritize claims to determine their complexity and urgency, help to manage the workload effectively and reduce delays, distinguish between high exposure and low exposure claims, ensuring that complex cases receive the necessary attention.

Investigation: Collect all necessary information and conduct appropriate investigations to determine the complexity and the urgency of the claims.

Evaluation:  Adhere to established claim handling guidelines, coverage, investigation, liability, damages, evaluation, and resolution of E&O claims across multiple jurisdictions.

Determine validity of claims and determine the appropriate course of action.

Risk Management: Identify and mitigate potential risks early in the claims process to protect the Company and the insureds from unnecessary financial exposure and legal issues.

Compliance: Maintain compliance with legal and regulatory requirements, ensuring that all actions taken are within the law and Company policies.

 Comply with team and individual and other key performance indicator metrics set by the Company.

Documentation and Reporting: Maintain file documentation of claims activities and assist with claim metrics reporting and identifying claim and industry trends.

Reserving protocols: Establish reserves pursuant to established reserving guidelines and authority procedures.

Litigation Management: Adhere to the Company’s Panel Counsel Program and Litigation Guidelines.

 Manage ALAE by selecting, instructing and managing third party vendors.

Coverage Letters: Ability to write coverage letters and work with coverage counsel.

Customer Satisfaction: Provide clear communication and updates to claimants, enhancing their experience and maintaining trust in the claims process.

Communication: Maintain close communication with underwriting, insureds, brokers, and defense counsel, and other functional units providing input and direction in case handling, and reporting on claim and industry trends

Other Duties: Undertake other duties from time to time as the Company may reasonably require.

Technical Knowledge and Understanding:
 


* Understanding of legal principles related to E&O claims, including coverage issues, liability, and damages.


* Ability to use data analytics to identify trends and improve claims handling processes and operational efficiencies.


* Strong decision-making skills to prioritize and negotiate and resolve claims effectively.


* Strong communication skills to maintain close relationships with underwriting, insureds, brokers, and defense counsel.


* Ability to write clear and concise coverage letters and reports.


* Ability to follow claim handling guidelines and leg...