Job Summary

The Senior Claims Examiner will manage a caseload of insurance claims pending under a moderate to low level of supervision. Job functions include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of insured's or insurer's liability; Reviewing and evaluating damages and determining strategies for resolution. Settling claims in accordance with policy provisions and within an authority level. The Sr. Claims Examiner will engage in verbal and written communication with brokers, claimants and policyholders. The Sr. Claims Examiner will ensure that all state claims handling requirements are met and internal guidelines are followed. The Sr. Claims examiner will handle claims in accordance with established James River Claims Best Practices.

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
• Investigate allegations and determine facts based on evidence and interviews
• Draft disclaimers and reservation of rights letters when coverage issues arise
• Assign limited investigations and appraisals to licensed insurance professionals
• Negotiate settlements, mitigate losses, and control expenses
• Manage litigated files in accordance with Litigation Management Guidelines
• Provide technical guidance, assistance and training to co-workers
• Maintain a high level of communication internally with Claims Management team and externally with Insureds, claimants, attorneys and brokers.
• Frequently called upon to train new Claims Examiners
• Will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims

Knowledge, Skills and Abilities

• Excellent written and verbal communication skills
• Strong analytical skills
• Strong negotiation skills
• Excellent organizational skills
• Proficiency in MS Office (Word, Excel, Outlook)
• Ability to take direction from Claims Manager
• Ability to work independently with limited supervision
• Ability to work on assignments that require a higher technical level of expertise due to complexity and exposure, under minimal supervision
• Ability to work successfully as an individual contributor and in a team environment
• Recognized as having a high level of expertise in claim handling and suit management
• Ability to provide technical guidance and assistance, and train less experienced Claims Examiners
• Possess demonstrated technical knowledge and skills, including product and industry, reflective of successful progress
• 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.

Experience and Education

Senior Claims Examiner

• High school diploma required
• College degree preferred
• Minimum of five years P&C claims handling experience
• Experience and proven track record in managing complex coverage issues and complex litigation
• Multi-jurisdictional claims experience
• Adjuster license and/or certifications preferred

Claims Specialist

• High school diploma required
• College degree preferred
• Advanced degree or law degree preferred
• Minimum of seven years claims handling experience
• Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
• Experience working with complex coverage issues
• Multi-jurisdictional claims and litigation experience
• Adjuster license and/or certifications desired preferred

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