Claims Manager

  • ClassificationClaims
  • Salary
  • Work typeFull-time
  • LocationCalifornia
  • Posted on11 Jul 2017
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Position Description: Claims Manager analyzes coverage for complex claims submitted under the applicable policy form.  The duties of a Claims Manager include discussing claim facts and coverage issues with insureds, defense counsel and/or coverage counsel, and reinsured clients, particularly on more complex matters.  The Claims Manager is also responsible for managing reinsurance programs; this entails training and supervising of claims examiners. 

 

Essential Duties and Responsibilities:

  • Takes responsibility for training and supervising of Claim Examiners as needed
  • Performs file audits and employee performance reviews and makes recommendations
  • Reviews submitted claims for coverage and decide as to whether a matter is covered under the applicable policy.
  • Investigates complex claims and coverage issues.
  • Reviews examiners’ action plans, including coverage recommendations, and verify appropriate action is taken.
  • Establishes and revises claim reserves based on claim developments and counsel liability assessments.
  • Issues coverage determination letters, including reservation of rights and denial letters.
  • Appoints and liaison with defense and/or coverage counsel, as appropriate.
  • Obtains updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.
  • Authorizes settlements based on liability and other considerations within settlement authority provided by Underwriters or reinsured client.
  • Conducts detailed bill reviews to ensure appropriate payment.
  • Maintains a claim file by accurately documenting all communications, activity, etc.
  • Communicates with brokers or reinsured clients to obtain information necessary for processing claims.
  • Attends mediations, arbitration, trial, and conferences as needed.
  • Manages reinsurance programs.
  • Negotiates claims-handling protocols with reinsured clients and drafts the same based on agreed terms.
  • Updates senior claims staff and the Reinsurance Team on program developments and reinsured client feedback; advises examiners of same, if appropriate.
  • Attends meetings with reinsured clients.

Competencies:

  • Strong leadership and management skills
  • Extensive written and verbal communication skills are needed to provide proper supervision of claims activities
  • Ability to use computer software and database applications related to claims services.
  • Strong typing skills.
  • Excellent customer service and communication (verbal and written) skills.
  • Attention to detail.
  • Time management skills; ability to assist examiners in prioritizing their workloads.
  • Demonstrates a high level of professionalism with co-workers, management, and clients.

 

Education and Experience:

  • Bachelor’s degree preferred.
  • Knowledge of Microsoft Office.
  • Previous experience as Senior Claims Examiner.
  • A minimum of 12 years of handling claims experience.
  • A minimum of 5 years of managing or supervising claims personnel.

 

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