Senior Claims Examiner

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Senior Claims Examiner
The candidate will be responsible for investigating and managing claims—including, but not limited to, speaking with insureds and claimants; providing coverage analysis; assigning and working with defense counsel to ensure proper case management; establishing appropriate reserves; and negotiating resolution or issuing denials as appropriate. Will handle a more complex caseload and work with minimal supervision. Act as first point-of-contact for insureds regarding general claim questions and reporting of claims. Perform coverage analysis and prepare reservation of rights/declination letters when appropriate. Work with defense counsel in developing the case to include expert support and case strategy. Obtain expert reviews and conduct independent investigations when no defense counsel is assigned. Maintain cases on diary to ensure proper file management, evaluation, strategy, and timely reserve recommendations. Keep running notes current to reflect file development and ensure proper data is maintained in claims management system. Negotiate claim settlements at mediation or directly with plaintiff counsel as indicated, or issue denial to claimant/claimant attorney as appropriate. Attend first suit meetings, mediation, and trials. Attend and participate in Claims Review Committee meetings to provide strategy on claims file management. Should have solid understanding of basic insurance concepts, including coverage, policy language, liability, negligence, and damages. Should have strong organizational skills and ability to manage multiple tasks simultaneously. Bachelor’s Degree and/or JD with a minimum of 3 years of claims experience (bodily injury claims experience a plus) and/or medical malpractice defense. Must obtain applicable adjusters license(s) by state within 3 months of start date. 5-10 years of medical malpractice claims and/or medical malpractice defense experience preferred.

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