Professional Liability Claims Examiner III

Job DetailsLevel: ExperiencedJob Location: Atlanta Office - Atlanta, GA 30328Position Type: Full TimeEducation Level: High School Diploma or GEDSalary Range: $80,000.00 - $95,000.00 Salary/yearTravel Percentage: NoneJob Shift: DayJob Category: Admin - ClericalPOSITION 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 QualificationsQUALIFICATIONS 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: [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):