Claims Examiner - Executive Claims Examiner - New York Bodily Injury
JR Group, Raleigh, NC, United States
Come grow with James River Insurance!
James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.
At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2023, 2022, and 2021 Top Workplaces USA awards.
James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.
Job Summary
Under moderate supervision, the Claims Examiner manages a caseload of low to moderate complexity P&C insurance claims by reviewing claims to analyze and determine applicable coverage, facts, liability, damages, plan & strategy for resolution in accordance with state and company guidelines.
Duties and Responsibilities
- Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
- Perform coverage, liability, and damage analysis on all claims assignments
- May investigate allegations and determine facts based on evidence and recorded interviews
- Draft disclaimers and reservation of rights letters when coverage issues arise
- Assign limited investigations and appraisals to licensed insurance professionals
- Manage a caseload of low to moderate complexity claims with delegated authority
- Negotiate settlements, mitigate losses, and control expenses
- Assist in the management of litigated files
- Participate in and attend mediations to facilitate settlements
- Maintain accurate documentation in claim files
- Prepare correspondence to all required parties involved in a claim when necessary
- Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
- May assist in training existing and new Claims Associates
- Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
- Handle claims in accordance with established James River Claims Best Practices
- Other duties as required by management
- Beginner level of expertise in claim handling and suit management
- Moderate knowledge of P&C insurance industry
- Ability to effectively assess risk
- Proficiency in MS Office (Word, Excel, Outlook)
- Excellent written and verbal communication skills
- Excellent organizational skills
- Ability to take direction from management
- Ability to work independently and take initiative
- Ability to exercise sound judgement in making critical decisions
- Research, analysis and problem-solving skills
- Strong negotiation skills
- Ability to build effective relationships with business partners
- Ability to perform effectively as part of a team
- Ability to organize complex information and pay close attention to detail
- Ability to anticipate customer needs and take initiative to meet those needs
- Ability to train and provide technical guidance to less experienced Claims professionals
- Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter
Claims Examiner
- High school diploma required
- Bachelor's Degree preferred
- Minimum of one year of P&C claims handling experience including handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
- Adjuster license and/or certifications preferred
- High school diploma required
- Bachelor's Degree preferred
- Minimum of three years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorney required
- Adjuster license and/or certifications preferred
- High school diploma required
- Bachelor's Degree preferred
- Advanced Degree or Juris Doctorate Degree preferred
- Minimum of seven years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
- Adjuster license and/or certifications desired preferred
- High school diploma required
- Bachelor's Degree preferred
- Advanced Degree or Juris Doctorate Degree preferred
- Minimum of ten years of P&C claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
- Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
- Project management and process implementation experience preferred
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Other details
- Job Family Claims
- Job Sub Family Operations
- Pay Type Salary
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