Commercial General Liability Claims Examiner I Or Ii

DescriptionPharmacists Mutual has an opening for a Commercial General Liability Claims ExaminerI or II. This position will investigate, evaluate, reserve, negotiate and resolve assigned claims in accordance with Company guidelines. The Examiner will provide timely, professional claim handling and superior customer service.

Claims Examiner I

General and Professional Liability:

• Manage, evaluate and resolve lower severity third party bodily injury, including professional liability, and property damage claims.

Claims Examiner II

General and Professional Liability:

• Manage, evaluate and resolve lower severity third party bodily injury and property damage claims.

Essential Functions

Essential functions may include, but are not limited to the following:

• Communicate regularly and effectively with members to obtain claim information and provide updates.
• Perform timely coverage analysis based on policy information and facts or allegations of each case.
• Investigate each claim to determine the extent of liability, damages, and contribution potential.
• Take necessary statements (recorded); completes outside investigation as needed per case specifics.
• Maintain claim files and documents claim file activities in accordance with established protocols, guidelines, procedures, and metrics.
• Establish and maintains proper loss, indemnity and expense reserves.
• Recommend, attend, and/or present at claims roundtable for collaboration of technical expertise.
• Manage the resolution of assigned claims by negotiating disposition of claims with insureds and claimants or their legal representatives.
• Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Manage the coordination of outside resources, including vendors, adjusters and attorneys.
• Identify and assist in pursuing fraud and subrogation opportunities.
• Work with other examiners in oversight or team handling situation or assignments.
• Provide consulting and training resources for internal sales and business partners.

Knowledge, Skills and Abilities

• Understand principles and practices of insurance claims examination.
• Understand policy and contract coverage.
• Demonstrate empathy to those who suffered a loss.
• Ability and flexibility to work longer hours when workload fluctuations occur.
• Ability to handle large volumes of work in a short period of time.
• Research and stay up-to-date with trends and changes in the claims/insurance industry.
• Appropriately deal with information that is considered personal and confidential.
• Obtain and use sensitive information discreetly and objectively, both internal and external.
• Communicate effectively with others (oral and written).
• Analyze complex issues and make critical decisions.
• Correct English usage, spelling, grammar, vocabulary and punctuation.
• Maintain records, prepare reports and conduct correspondence related to the work.
• Interpret and apply laws, rules and regulation, as well as policy and contract coverage.
• Determines when to escalate concerns to the appropriate level of management.
• Follow oral and written directions.
• Work effectively with others in a team environment.
• Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
• Establish and maintain effective working relationships with those contacted in the course of work.
• Excellent customer service skills.
• Ability to organize and prioritize work.
• Work independently and demonstrate drive and initiative.
• Ability to meet definite deadlines and deal with pressure situations.
• Collect, interpret, and input data efficiently and accurately.
• Use computer and related software effectively.
• Use Microsoft Office programs efficiently and effectively.

Qualifications
Experience and Education Qualifications

Claims Examiner I

• High School Diploma or equivalent and 5 years of related experience; or
• Associate’s Degree or equivalent and 3 years of related experience; or
• Bachelor’s Degree

Claims Examiner II

• High School Diploma or equivalent and 7 years of related experience; or
• Associate’s Degree or equivalent and 5 years of related experience; or
• Bachelor’s Degree and 3 years of related experience; or
• Master’s Degree

Special Requirements, Licenses and Certificates

• All levels - Texas Claims Adjuster License (or obtained within 6 months of hire)

Preferred QualificationsLicenses, Certifications or Designations

• One of the following industry related certifications; AIC (Associate in Claims), ARM (Associate in Risk Management), ARe (Associate in Reinsurance), CLS (Claims Law Specialist), CLA (Claims Law Associate), or SCLA (Senior Claims Law Associate)