Claims Examiner II, Professional Lines

About the position

The Claims Examiner II position at Tokio Marine HCC involves analyzing coverage for increasingly complex claims submitted under applicable policy forms, specifically focusing on wage and hour claims. This role is not related to medical billing or health insurance. Under immediate supervision, the Claims Examiner II will be responsible for reviewing submitted claims to determine coverage, investigating complex claims and coverage issues, and drafting action plans with coverage recommendations for Claims Managers. The position requires independent handling of claims with minimal coverage issues and establishing and revising claim reserves based on developments and liability assessments. In addition to these responsibilities, the Claims Examiner II will draft coverage determination letters, including reservation of rights and denial letters, and appoint defense or coverage counsel as necessary. The role also involves obtaining updates from counsel and the insured, updating claims diaries based on activities, and authorizing settlements within the authority provided by the Claims Manager. The Claims Examiner will review, approve, and reimburse the insured for legal and expert/vendor invoices and settlements, conduct detailed bill reviews, and maintain accurate documentation of all communications and activities in the claim file. Communication with brokers or reinsured clients to gather necessary information for processing claims is also a key aspect of this role. The Claims Examiner II may attend mediations and arbitrations as needed and assist the Claims Manager in drafting claims-handling protocols.

Responsibilities
? Review submitted claims for coverage and determine if a matter is covered under the applicable policy.
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? Investigate increasingly complex claims and coverage issues.
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? Draft action plans, including coverage recommendations, for the approval of Claims Managers for complex claims.
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? Independently handle claims with little to no coverage issues.
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? Establish and revise claim reserves based on claim developments and counsel liability assessments.
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? Draft coverage determination letters, including reservation of rights and denial letters.
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? Appoint defense and/or coverage counsel, as appropriate.
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? Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.
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? Update claims diary as needed based on activity.
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? Authorize settlements based on liability and other considerations within settlement authority provided by Claims Manager.
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? Review, approve, and reimburse the Insured for legal, expert/vendor invoices, and settlement.
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? Conduct detailed bill reviews to ensure appropriate payment.
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? Maintain a claim file by accurately documenting all communications, activity, etc.
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? Communicate with brokers or reinsured clients to obtain information necessary for processing claims.
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? Attend mediations, arbitration, etc. as needed.
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? Assist Claims Manager in drafting claims-handling protocols.

Requirements
? High school diploma or the equivalent; Bachelor's degree preferred.
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? Minimum of two years of relevant and progressive professional experience as a Claims Examiner.
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? Possess and have ability to apply knowledge of principles, practices, and procedures.
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? Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy.
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? Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously.
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? Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business.
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? Experience using Microsoft Office package (Excel, Access, PowerPoint, Word).
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? Time management skills.

Nice-to-haves

Benefits
? Competitive salary and employee benefits package.
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? Equal pay opportunities for equal work regardless of various protected statuses.

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