Senior Claims Examiner - Claims Specialist - New York Labor Law

Job Summary

Under minimal supervision, the Senior Claims Examiner - Claims Specialist manages a caseload of moderate to high complexity New York Labor Law commercial insurance claims. The incumbent will review claims to analyze and determine applicable coverage, facts, liability, damages, and plan for resolution in accordance with state and company guidelines. The incumbent will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims.

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
• Manage a caseload of moderate to high complexity claims with delegated authority
• Manage litigated files
• Negotiate settlements, mitigate losses, and control expenses
• Participate in and attend mediations to facilitate settlements
• Maintain accurate documentation in claim files
• Prepare correspondence to all required parties involved in a claim
• Provide technical guidance, assistance, and training to Claims Associates and Claims Examiners
• Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
• Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
• Maintain a passing quality assurance score on all audits and QAs
• Handle claims in accordance with established James River Claims Best Practices
• Other duties as required by management

Knowledge, Skills and Abilities

Experience and Education

Senior Claims Examiner

Claims Specialist

High school diploma required

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