Claims Casualty Examiner

Description:

The Claims Casualty Examiner is responsible for investigating, evaluating, negotiating, and resolving casualty claims in accordance with company policies, regulatory requirements, and industry best practices. Depending on level, the examiner may handle claims ranging from routine matters to complex, high-exposure, and litigated losses. This position works closely with policyholders, claimants, attorneys, agents, medical providers, vendors, and internal departments to ensure fair and timely claim resolution while delivering exceptional customer service.

Reports To: Claims Casualty Supervisor

Duties/Responsibilities

• Investigate casualty claims by gathering and analyzing statements, reports, records, and other relevant documentation.
• Review and interpret policy language to determine coverage.
• Evaluate injuries and property damages, establish and maintain appropriate reserves, and develop resolution strategies.
• Negotiate settlements with claimants and attorneys
• Maintain accurate, timely, and complete claim documentation.
• Communicate effectively with policyholders, claimants, agents, attorneys, medical providers, and other involved parties.
• Identify, investigate, and address potential fraud.
• Manage claims in compliance with company standards, state regulations, and industry best practices.
• Monitor claim inventories to ensure timely file progression and resolution.
• Participate in claim reviews, audits, training programs, and continuing education activities.
• Provide technical assistance and mentorship to less experienced examiners, as appropriate based on level.
• Assist with special projects, departmental initiatives, and catastrophe response efforts as assigned.

Requirements:

• Knowledge of casualty insurance coverages, liability principles, and claims handling practices appropriate to assigned level.
• Strong analytical, investigative, and problem-solving skills.
• Effective negotiation and conflict-resolution abilities.
• Excellent verbal and written communication skills.
• Strong organizational and time-management skills with the ability to manage multiple priorities.
• Ability to interpret insurance policies, legal documents, medical records, and other claim-related materials.
• Proficiency with claims management systems and Microsoft Office applications.
• Ability to exercise sound judgment and make informed decisions.
• Strong customer service and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Education and Experience

• Claims Casualty Examiner I
• Bachelor's degree preferred in Business, Insurance, Risk Management, or Criminal Justice, Communications, or a related field.
• 0-2 years of insurance, claims, customer service, legal, or related experience.
• Ability to obtain and maintain required licensing and company certifications.
• Claims Casualty Examiner II
• Bachelor's degree preferred in Business, Insurance, Risk Management, or Criminal Justice..
• 3-5 years of casualty claims handling experience.
• Skilled in claims investigation, timely reserving, settlement negotiations and diary management.
• Litigation management experience
• Progress toward professional insurance designations such as AIC or CPCU preferred.
• Claims Casualty Examiner III
• Bachelor's degree preferred in Business, Insurance, Risk Management, or Criminal Justice
• 5+ years of casualty claims handling experience, including complex and litigated claims.
• Demonstrated expertise in liability analysis, reserve evaluation, negotiation skills, diary management and litigation management.
• Professional insurance designations such as AIC, CPCU, ARM, or SCLA preferred.

Physical Requirements

This position requires the ability to sit for extended periods while working at a computer, both in a home and office environment. The role involves frequent use of a headset, keyboard, mouse, and other standard office equipment. Occasional movement within the office may be required, such as walking to meetings or accessing shared equipment.

Pay Range:

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of Utica First’s total compensation package for employees.