Commercial Auto & GL Claims Examiner II

Job DetailsLevel: ExperiencedJob Location: Involuntary - Unit 3 - Remote - All States, PA 19107Position Type: Full TimeEducation Level: High School Diploma or GEDSalary Range: $75,000.00 - $85,000.00 Salary/yearTravel Percentage: NoneJob Shift: DayJob Category: Admin - ClericalPOSITION SUMMARY: Responsible for the prompt review and interpretation of policy information to determine coverage for claims involving loss, damage, or injury. Conducts thorough claim investigations and evaluations through final resolution, including claims in litigation. Maintains frequent communication with claimants, legal representatives, clients, defense counsel, and other involved parties. Provides clients with well-supported recommendations regarding claim exposure, reserves, litigation strategy, and settlement. Position is remote/working from home. DUTIES AND RESPONSIBILITIES: Review and interpret policy coverage and investigate, evaluate, negotiate, and resolve assigned commercial automobile and general liability claims. Apply California public entity laws, statutes, regulations, and claims-handling requirements to assigned matters. Conduct field investigations and site inspections when required. Coordinate and direct outside investigative service providers, appraisers, experts, defense counsel, and other vendors. Work closely with clients, client counsel, and investigative services to advance claims toward timely resolution. Maintain an accurate and current diary for all assigned claims. Continually assess claim exposure and establish or recommend accurate reserves and settlement authority. Prepare comprehensive loss reports that provide a thorough analysis of coverage, liability, damages, exposure, litigation strategy, and recommended resolution. Identify potential subrogation, contribution, indemnification, or other risk-transfer opportunities and initiate recovery efforts in the client’s direction. Document all correspondence, reports, discussions, evaluations, and claim decisions accurately and promptly in the claim file. Attend city council meetings, claim-review meetings, mediations, settlement conferences, site inspections, and other proceedings in person when required. Prepare and present clear, concise claim summaries and recommendations to clients and other stakeholders. Maintain compliance with client service instructions, company procedures, regulatory requirements, and industry best practices. Provide responsive and professional service to clients and other parties involved. Perform other duties and special projects as assigned. QualificationsQUALIFICATIONS REQUIRED: Education/Experience:  High school diploma or GED required. Bachelor’s degree in business, insurance, risk management, criminal justice, or a related field preferred. A minimum of five years of experience handling California public entity commercial automobile and general liability claims required. An equivalent combination of relevant education, training, and progressively responsible claims experience may be considered, provided the candidate possesses the required California public entity claims experience. Knowledge, Skills, and Abilities Thorough knowledge of California public entity claims laws, statutes, immunities, procedures, and filing requirements. Knowledge of commercial automobile and general liability coverage, investigation techniques, litigation management, damages assessment, and claim valuation. Ability to independently analyze complex coverage, liability, causation, damage, and exposure issues. Advanced analytical, decision-making, negotiation, and problem-solving skills. Working knowledge of the litigation process, including pleadings, discovery, depositions, mediation, trial preparation, and legal budgeting. Ability to manage outside counsel and investigative service providers effectively. Strong verbal and written communication skills, including the ability to prepare professional loss reports and present claim recommendations. Ability to manage client relationships and provide high-quality service in a fast-paced environment. Ability to follow detailed written and verbal instructions and respond to requests accurately and efficiently. Strong organizational, time-management, and prioritization skills. Ability to manage assigned claims with minimal supervision while meeting applicable deadlines and diary requirements. Proficiency with claims-management systems and standard business applications, including Microsoft Office. Ability to exercise sound judgment, discretion, flexibility, initiative, and professionalism. At least five years of Automobile and General Liability California Public Entity claims experience required. Should reside in the Sacramento, CA vicinity Knowledge of California Public Entity claims statutes,  handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge. Other Qualifications:  Candidate must have a California Adjuster License.                                                           Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]                                       MENTAL AND PHYSICAL REQUIREMENTS   1.  MENTAL EFFORT   a.      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.   2.  PHYSICAL EFFORT   a.      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 occasionally b.   Exerting up to 10 pounds frequently c.   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 occasionally b.   Exerting up to 20 pounds of force frequently c.   Exerting up to 10 pounds of force constantly to move objects           Heavy work: a.   Exerting up to 100 pounds of force occasionally b.   Exerting up to 50 pounds of force frequently c.   Exerting up to 20 pounds of force constantly to move objects           Very heavy work: a.   Exerting in excess of 100 pounds of force occasionally b.   Exerting in excess of 50 pounds of force constantly to move objects c.   Exerting in excess of 20 pounds of force constantly to move objects         Visual requirements necessary to perform the job:            Far vision:  clarity of vision at 20 feet or more    X         Near vision:  clarity of vision at 20 inches or less    X        Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet            Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are            Color vision:  ability to identify and distinguish colors            Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point   2.  PHYSICAL EFFORT (cont.)   FREQUENCY   c.   Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):               Climbing:     Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms.  Body agility is  emphasized.  This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.               Balancing:    Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces.  This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.    X Stooping:   Bending body downward and forward by bending spine at the waist.  This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.    X        Kneeling:     Bending legs at knee to come to a rest on knee or knees.    X Crouching: Bending the body downward and forward by bending legs and spine.         Crawling:  Moving about on hands and knees or hands and feet.    X Reaching:  Extending hand(s) and arm(s) in any direction.    X        Standing:      Particularly for sustained periods of time.    X Walking:   Moving about on foot to accomplish tasks, particularly for long distances.    X Pushing:    Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.    X        Pulling:        Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.         Foot        Motion:     Using feet to push pedals.    X Lifting:      Raising objects from a lower to a higher position or moving objects horizontally from position to position.  This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.    X Fingering:  Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.    X Grasping:   Applying pressure to an object with the fingers and palm.                             Occasionally       Occasionally   Occasionally       Occasionally   Occasionally   Occasionally   Occasionally     Occasionally           Frequently         Frequently     Occasionally                   2.  PHYSICAL EFFORT (cont.)            FREQUENCY  X        Talking:          Expressing or exchanging ideas by means of the spoken word.  Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.    X        Hearing:          Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.         Feeling:     Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.    X        Repetitive       Substantial movements (motions) of the wrists, hands,       Motion:      and/or fingers. Frequently       Frequently               Frequently     3.  WORKING CONDITIONS   Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.        WORKING CONDITION        ENVIRONMENTAL                  FACTOR         NATURE/REASON            OF EXPOSURE               FREQUENCY Dirt/Dust     Noise     Temperature extremes     Dampness     Vibrations     Equipment movement hazard     Chemicals/solvents     Electrical shock     Significant work pace/pressure     Odors/Fumes     Other (specify):