ProSight Specialty Insurance

  • Claims Examiner

    Job Locations US-NJ-Morristown
    Posted Date 2 weeks ago(12/2/2019 9:42 AM)
    Job ID
    2019-2119
    # of Openings
    1
    Category
    Claims
  • Overview

    ProSight’s fast paced and dynamic Claim Department is looking for a highly motivated Claims Examiner.  This individual will be responsible for the investigation, evaluation and resolution moderately complex claims within our department. The number of claims assigned on a monthly basis and average number of pending claims will vary based on the type of claims assigned, level of complexity, jurisdiction and other factors. Our new team member will need to adapt to a changing environment of varied lines of coverage and have the ability to take on new responsibilities. This is an ideal position for a claim professional seeking a unique opportunity to utilize their skills and grow with an expanding team of claim professionals.

    Responsibilities

    • Investigates, maintains, and settles claims under moderate supervision
    • Conduct thorough, high-quality investigations and utilize outside resources as necessary.
    • Assigned claims may involve coverage interpretation and litigation, including specialized coverage extensions.
    • Prepares appropriate coverage letters for review and approval by claims management.
    • Completes an investigation on each claim in a timely manner and fully documents the claim file with claim details.
    • Handles assigned claims following company guidelines and industry best practices.
    • Promptly identifies claims that have significant exposure or suspected fraudulent activity.
    • Oversight responsibilities for a TPA to add value and claims expertise.
    • Sets accurate reserves on each claim within given authority level and promptly advises management of claims that will require reserves exceeding authority.
    • Completes timely and high quality large claim reports with limited management input and editing.
    • Maintains a diary system that assures that each assigned claim will receive necessary ongoing attention.
    • Travels to attend mediations, settlement conferences and trials as needed.
    • Uses the claims system to accurately change reserves and make payments within assigned authority levels.
    • Closely manages defense counsel, outside investigators and surveyors to ensure that loss adjustment expenses are appropriate.
    • Meets with members of other departments to discuss specific claim details or general claims issues.
    • May be designated as claims contact for key accounts and programs in which case the Examiner will perform various account or program management tasks including:
    • Preparing for and attending claim reviews
    • Analyzing claims data and meeting with members of other departments to discuss the account status
    • Meeting with and making presentations to account or program representatives
    • Maintains adjuster licenses in states as required.
    • May be called upon to perform other tasks and duties within the claims department as dictated by business needs.

    Qualifications

    • 2-4 Years of Experience specific to LOB and Complexity of Program
    • Bachelor’s degree preferred
    • Prior P&C insurance experience is a plus
    • Ability to evaluate policy language and apply to claim
    • Willingness to accept challenges and take on new responsibilities
    • Solid planning & organizational skills including time-management and prioritization
    • Analytical skills to identify, gather, and organize information
    • Customer focused attitude and skills to resolve inquiries quickly and effectively
    • Strong verbal & written communication skills
    • Possess strong business judgement
    • Excellent investigation, organizational and analytical skills
    • Ability to interpret and apply customized Insurance policies to real life situations.
    • Works within clearly defined limits
    • Authority Target: 25/10 depending on LOB

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