Claims Examiner II

Tokio Marine HCC


Date: 2 weeks ago
City: Encino, CA
Salary: $68,300 - $93,830 / year
Contract type: Full time
Tokio Marine HCC

Claims Examiner


Under supervision, analyzes coverage for increasingly complex claims submitted under the applicable policy form. Discusses claim facts and coverage issues with insureds, defense counsel, and/or coverage counsel. Possesses critical thinking and strong oral/written communication skills.


Key Responsibilities:


Relying on limited experience and knowledge, the Claims Examiner II is responsible for accomplishing the following assignments. These assignments are varied in nature.



  • Review submitted claims for coverage and determine if a matter is covered under the applicable policy.

  • Investigate increasingly complex claims and coverage issues.

  • Draft actions plans, including coverage recommendations, for the approval of Claims Managers for complex claims.

  • Independently handle claims presently little to no coverage issues.

  • Establish and revise claim reserves based on claim developments and counsel liability assessments.

  • Draft coverage determination letters, including reservation of rights and denial letters.

  • Appoint defense and/or coverage counsel, as appropriate.

  • Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.

  • Update claims diary as needed based on activity

  • Authorize settlements based on liability and other considerations within settlement authority provided by Claims Manager.

  • Review, approve, and reimburse the Insured for legal, expert/vendor invoices, and settlement.

  • Conduct detailed bill reviews to ensure appropriate payment.

  • Maintain a claim file by accurately documenting all communications, activity, etc.

  • Communicate with brokers or reinsured clients to obtain information necessary for processing claims.

  • Attend mediations, arbitration, etc. as needed.

  • Assist Claims Manager in drafting claims-handling protocols.


Planning



  • Follow work plans, established timelines, and pre-defined goals for assigned work.

  • Meet commitments on deadlines.


Communication



  • Communicate activities, results, and observations with employees and management as appropriate.


Cost Management



  • Identify areas for improvement in existing business practices.

  • Perform work thoroughly in a cost-efficient manner and at a high productivity level.


Business Controls and Policies



  • Comply with all corporate policies and procedures.

  • Report any breakdowns in controls to management.

  • Conduct all activities in a safe manner.


People Management



  • No people management responsibility.


Position Knowledge, Skills, and Requirements:


Education



  • High school diploma or the equivalent

  • Bachelor’s degree preferred


Experience



  • Minimum of two years of relevant and progressive professional experience as a Claims Examiner


Other



  • Possess and have ability to apply knowledge of principles, practices, and procedures

  • Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy

  • Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously

  • Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment

  • Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)

  • Time management skills.


Work Schedule: Hybrid – 3 to 2 days in office


California and New York Residents Only


For candidates working in person or remotely in the following locations, the reasonable pay range for this specific position is $68,300 -$93,830 annually Encino, CA, and $74,500 - $102,300 annually Mount Kisco, New York. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, gender identity, gender expression, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws. The salary range is the range THMCC, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future, and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the pay range, the actual compensation will vary depending on the above factors as well as market and business considerations.


The Tokio Marine HCC Group of Companies offers a competitive salary and employee benefits package. We are a successful, dynamic organization experiencing rapid growth and are seeking an energetic and confident individual to join our team of professionals. The Tokio Marine HCC Group of Companies are equal opportunity, employers. Please visit www.tmhcc.com for more information about our companies.


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