Senior Claims Examiner - Claims Specialist - Construction Defect
Alpharetta, GA, United States
Come grow with James River Insurance!
James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.
At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2023, 2022, and 2021 Top Workplaces USA awards.
James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.
Job Summary
The Senior Claims Examiner will manage a caseload of insurance claims pending under a moderate to low level of supervision. Job functions include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of insured's or insurer's liability; Reviewing and evaluating damages and determining strategies for resolution. Settling claims in accordance with policy provisions and within an authority level. The Sr. Claims Examiner will engage in verbal and written communication with brokers, claimants and policyholders. The Sr. Claims Examiner will ensure that all state claims handling requirements are met and internal guidelines are followed. The Sr. Claims examiner will handle claims in accordance with established James River Claims Best Practices.
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
Negotiate settlements, mitigate losses, and control expenses
Manage litigated files in accordance with Litigation Management Guidelines
Provide technical guidance, assistance and training to co-workers
Maintain a high level of communication internally with Claims Management team and externally with Insureds, claimants, attorneys and brokers.
Frequently called upon to train new Claims Examiners
Will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims
Knowledge, Skills and Abilities Excellent written and verbal communication skills
Strong analytical skills
Strong negotiation skills
Excellent organizational skills
Proficiency in MS Office (Word, Excel, Outlook)
Ability to take direction from Claims Manager
Ability to work independently with limited supervision
Ability to work on assignments that require a higher technical level of expertise due to complexity and exposure, under minimal supervision
Ability to work successfully as an individual contributor and in a team environment
Recognized as having a high level of expertise in claim handling and suit management
Ability to provide technical guidance and assistance, and train less experienced Claims Examiners
Possess demonstrated technical knowledge and skills, including product and industry, reflective of successful progress
Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter.
Experience and Education
Senior Claims Examiner High school diploma required
College degree preferred
Minimum of five years P&C claims handling experience
Experience and proven track record in managing complex coverage issues and complex litigation
Multi-jurisdictional claims experience
Adjuster license and/or certifications preferred
Claims Specialist High school diploma required
College degree preferred
Advanced degree or law degree preferred
Minimum of seven years claims handling experience
Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
Experience working with complex coverage issues
Multi-jurisdictional claims and litigation experience
Adjuster license and/or certifications desired preferred
Other details Job Family Claims
Job Sub Family Operations
Pay Type Salary
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