Senior Claims/TPA Oversight Examiner

About you and the role:

The Senior Claims Examiner is responsible for adjusting claims and/or providing TPA oversight of the various entities under management. The role requires the ability to deal with a wide range of losses including high value and complex claims. The examiner, with minimal oversight, will lead and direct junior examiners, TPAs, and vendors. The role is responsible for performance, development, and coaching to maximize performance.

What you will be doing:

Key Accountabilities / Deliverables

• To ensure that implications for stakeholders, particularly policyholders, are given appropriate consideration in our business approach to deliver fair customer outcomes
• The adjusting of Claims either via paper or electronic presentations as required for all Syndicates and/or Group Companies
• Investigate, evaluate, negotiate, and adjudicate claims within authority and in a manner that consistently meets or exceeds our Claims Policies and Procedures
• Assist with initial triage, onboarding reviews, and scheduling of roundtable discussions
• Provide coaching, feedback, and direction on claims
• Manage the Claim Status Report documentation process
• Ensure all data is concise and accurate in electronic claim systems
• Use electronic diary systems to manage all claims
• Utilize data including loss runs to manage claims
• Setting appropriate and accurate case reserves in accordance with the company’s reserving philosophies
• Manage attorneys and negotiate and liaise with co-insurers
• Negotiating settlements as part of the market and pro-actively seek to identify and progress direct settlements solely for Enstar companies or to extend market settlements to other Enstar companies
• Reporting of claim developments and account information to management and the Litigation Legal team as applicable
• Contract interpretation, managing cedant relationships and legal representation
• Conducting inspection of records when required and negotiating equitable claim resolution
• Monitoring and oversight of external agreement parties against SLA’s and reporting any performance issues to Management
• Complying with Enstar claims handling authority levels
• Supporting and assisting Outwards, Commutation and Complex Claims teams as required
• Carry out duties within our internal policies and procedures in accordance with applicable law, rules, regulation, good governance and Enstar’s shared values, including putting clients at the heart of our business
• Work with external customers to address questions, resolve problems, and maintain rapport
• Assist with the Reinsurance reporting process
• Maintain applicable adjuster licensing
• In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require
• Serve as the lead and primary point of contact for TPAs and vendors
• Recognized as a claims expert and specialist within the organization
• Resolve complex claims issues and disputes
• Provide analysis of claims data, metrics, and results from TPA performance to effectively manage a portfolio of claims. Ability to communicate points and conclusions to relevant parties in a matter that matches the given audience’s need to level of detail and communication preferences.
• Provide periodic reports to management
• Coordinate claim reviews and provide data summaries
• Drive the performance management process for TPAs by communicating expectations, monitoring and evaluating performance, providing feedback and facilitating development
• Maintain transparent communication by appropriately communicating organizational information to TPAs through meetings, emails and regular communications
• Manage corporate expenses by monitoring file allocations, resources and other expenditures to ensure appropriateness
• Ensure compliance with all legal, regulatory, and internal control requirements
• Provide claims insights to assist other business units by collaborating on data analysis and trends
• Maintain professional and technical knowledge by attending educational workshops, professional publications, establishing personal networks, and participating in professional societies

What you will bring:

• Technical knowledge of Property & Casualty claims
• Significant experience (8+ years) in adjusting claims relevant to the classes of business handled
• Good knowledge of contract wordings, coverage, and reinsurance structures
• Detailed understanding of good faith claims handling
• Working knowledge of State specific Claims Handling Guidelines
• General understanding of legal principles as they pertain to insurance claims.
• Bachelor’s degree preferred
• Ability to serve as a resource, train, and mentor junior staff, based on being an expert within the organization
• Analytical skills
• Knowledge of insurance regulations and industry best practices
• Ability to work independently
• Excel proficiency
• Experience managing a Casualty and/or Professional Liability portfolio preferred
• Exposure to participation in due diligence reviews preferred
• Presentation skills
• Understanding of actuarial concepts

Your Benefits:

• Enstar offers best-in-class Medical, Dental, and Vision healthcare for single and family coverage.
• Board-certified doctors and pediatricians are available virtually 24/7 for urgent care.
• Access to Health Savings Account (HSA) or Flexible Spending Account (FSA).
• Access to Dependent Care FSA to cover daycare expenses.
• Access to Employee Assistance Programs (EAP) for health and well-being.
• Optional Pet & Home/Auto Insurance.
• Wellness Reimbursement program (up to $600 annual reimbursement for wellness-related expenses, i.e., gym memberships, massage, etc.).
• 401K retirement plan (company matches up to 6% of employee contribution).
• One paid annual volunteer day.

General Info

The target base salary pay range for this role is $95,000-$135,000*

*Target full-time equivalent base salary range is based on relevant market data. The actual salary offered will depend on applicable market data for hiring location and relevant candidate knowledge, skills/experience. This salary range is not inclusive of applicable discretionary incentives.