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Senior Claim Examiner

JOB SUMMARY

Responsible for the direct handling of a claim caseload which includes complex casualty claim files (including auto), including the monitoring and supervision of independent claims adjusters, attorneys, vendors and support personnel to ensure the timely, accurate and fair investigation, evaluation and disposition of all claims assigned.  The Senior Claim Examiner may also have responsibility for support personnel.  Employee should possess demonstrated expertise in handling significant losses of complexity and severity including severe bodily injury, pollution and property damage claims which involve comparative negligence legal theories with sophisticated nuances.  Employee should be highly skilled in all coverage’s written with an emphasis on the most difficult losses and exposures, and be capable of seeing our most difficult adjustments through final resolution using a wide variety of settlement techniques including litigation. Claim outcomes must be consistent with policy terms and conditions, damages and legal requirements.  Directly manage and oversee the assigned adjusting and support personnel and assure that they adhere to and comply with all Claim File Handling Guidelines and all other job expectations, regulations and requirements.

DUTIES & RESPONSIBILITIES

  • Directly handle and monitor assigned claims to produce results consistent with policy language, damages and legal requirements.
  • The Senior Claim Examiner may be responsible for the selection and oversight of independent adjusting firms, attorneys, experts and vendors.
  • Monitor and review the claim work product and perform periodic audits or re-inspections to ensure that productivity levels are met, and that defined quality standards are achieved.
  • Review new losses and files on diary to ensure reserve adequacy, while providing appropriate file direction to the adjusting firms, experts, vendors, resources, etc.
  • Monitor legal and loss adjustment expense and take steps to avoid or mitigate expenses wherever reasonably feasible.
  • Assist coworkers and others interested with referrals to quality service providers as needed.
  • Review coverage questions and provide direction, interpretation and approval.
  • Refer appropriate coverage matters to Claim Manager.
  • Ensure appropriate file handling, documentation and expense control of all assigned files.
  • Provide accurate, courteous and timely information to all external and internal customers concerning claim status and other inquiries.
  • Coordinate reporting to reinsurers, E&O carrier, accounting and brokers per protocols.
  • Provide service calls to policyholders and agencies as needed.
  • Serve as a technical resource within the Department through mentoring and knowledge sharing.
  • Draft coverage correspondence, including reservation of rights and coverage disclaimer along with composing detailed correspondence to insureds, claimants, attorneys, etc.
  • Attend trials, depositions, EUO’s, arbitrations and mediations where strategically advantageous or required by jurisdiction.
  • Write and administer timely, comprehensive performance appraisals of assigned support staff.
  • Recommend appropriate salary adjustments based upon actual job performance.
  • Suggest improvements to processes within the department, or serve on committees, to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, systems upgrades, etc.
  • Set file direction on complicated or high-exposure matters within purview and recommend appropriate reserves on claim files within specific authority and on files requiring reporting to senior management.
  • Confer with claim management, representatives, and other company personnel to plan, evaluate goals/objectives, resolve problems, and exchange information.
  • Regulate referrals; produce reports analyzing performance levels and territory performance.
  • Monitor and maintain diaries and task counts.
  • Take primary or secondary responsibility for strategic functions and projects such as CAT planning/teams, workflow design or systems modifications.
  • Evaluate, procure, coordinate and deliver technical training to agents, adjusters and clerical personnel.
  • Respond to customer, agency and Insurance Department correspondence.
  • This position is expected to directly handle certain claims entirely
  • Performs other duties or special projects as required or as assigned.

 

SUPERVISION RECEIVED

The Claim Manager provides general direct supervision.

SUPERVISION EXERCISED

The Senior Claim Examiner may have minimal direct responsibility for support staff.

QUALIFICATIONS

  • Bachelor's degree in business, insurance or a related field, or its equivalent.
  • Ten or more years of relevant claim supervisory and technical experience with demonstrated achievement and progressive responsibilities.
  • Extensive knowledge of the technical aspects of casualty claims (including automobile, casualty, subrogation and litigation).
  • Knowledge of casualty claims management, systems and regulatory requirements.
  • Demonstrated commitment to professional development through continuing education related to the job through the attainment of recognized industry designations such as AIC, AEI, J.D. or CPCU programs, etc.
  • Appropriate state Adjuster’s License(s) where required by law.
  • For field based positions, previous outside experience is preferred and valid driver’s license required.
  • Finely tuned skills in the technical aspects of casualty claims, including extensive knowledge of relevant contract and tort law.
  • Thorough understanding of the insurance industry and company operations.
  • Superior analytical and negotiation skills.
  • Excellent verbal and written communication skills.
  • Proven planning, administrative and supervisory experience.
  • Demonstrated ability to exercise good judgment in dealing with professional and personnel matters.
  • Demonstrated ability to work effectively with a wide array of outside firms and organizations.
  • Demonstrated ability to deal effectively with company management, peers and co-workers.
  • Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); Experience with imaging and estimating programs preferred.
  • Ability to perform job responsibilities under stressful circumstances.

 

PHYSICAL DEMANDS/WORKING CONDITIONS

  • Predominately sedentary office position with high frequency of keyboarding/computer work required.
  • The physical demands are minimal and typical of similar jobs in comparable organizations.
  • The work environment is representative and typical of similar jobs in comparable organizations.
  • Occasional overnight travel.
  • Potentially subject to adverse weather and stressful situations with respect to claim disputes.

How to Apply:

Submit cover letter, salary requirements and resume, in strict confidence.

Apply Online


We consider applicants for all positions without regard to race, color, religion, sex, national origin, ancestry, place of birth, gender identity, physical or mental disability, sexual orientation, genetic information, age, or veteran status, or any other legally protected status. Applicants requiring accommodation in the application and/or interview process should contact the Human Resources Department at ContactHR@VermontMutual.com.

We offer a comprehensive and competitive benefits package for all of our employees:

Competitive Salary
Paid Time Off
401(k) Retirement Plan
Health Insurance
Dental Insurance
Vision Insurance

Life Insurance
Disability Insurance
Professional Development
Wellness Programs
Company-sponsored Events
...and more!

Questions? Please call us at 800-451-5000

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Agent Locations: Connecticut, Maine, Massachusetts, New Hampshire, New York State, Rhode Island and Vermont.