Claims Examiner

Claims Examiner

Job Summary

This position is responsible for the review and coordination of high exposure, complex and unique claim files to ensure reserves are properly set and maintained, demands and expenses are handled appropriately, and regulatory standards are adhered to for compliance. Subject matter expert in all disciplines. Reviews lawsuits and complex coverage issues for authority to refer to counsel. Responsible for oversight and monitoring of potential exposure on Umbrella policy claims. Provides guidance to ACE markets for the handling, strategy and conclusion of complex claim files. Supports the Claims business unit by providing a comprehensive level of technical support, training and assistance. Demonstrates discretion when assessing complex and unique claims. This is the highest level non-management position in Claims.
Job Duties

• Reviews and authorizes claim reserves and provides settlement recommendations. Provides strategic claims handling recommendations to claims personnel and counsel on the most complex, high exposure and unique claims files. High Severity team coordination. Adapt to changing laws, statutes, case law and Department of Insurance regulations.
• Reviews claim files to ensure completeness, timeliness, member service guidelines and reporting procedures are being adhered to for compliance and consistency. Oversight and monitoring for potential exposure of Umbrella policy claims and communicates to re-insurers if applicable.
• Provides management with recommendations and guidance regarding complex coverage issues to ensure the Exchange is protected against risk. Reviews lawsuits for authority or recommendations to settle or refer to counsel.
• Ensures accurate diaries are established and maintained and provides guidance in litigation strategy. Reviews legal expenses, completes large payment and decision support tool analysis to monitor expenses and severity.
• Analyzes and reports patterns and trends to management and may be involved in extra contractual cases. Based on trends may provide training, calibrate performance, provide recommendations and insight for improvement to claims and legal personnel. Ensures reporting procedures are adhered to.
• Conducts annual audits as directed by senior management.
• Must exercise discretion when assessing complex and unique claims. Facilitate and recommend investigative needs, value and distinguish between allegations and facts while assessing risk. Reviews complex coverage issues and lawsuits for authority and/or recommendation to settle or refer to counsel. Provides severity, expense and decision support tools analysis and training.
• Adapt to changing laws, statutes, case law and Department of Insurance regulations.

Qualifications

• Bachelors Equivalent combination of education and experience Required
• 7-9 years Claims technical experience within a related specialized area Required
• 1-3 years Supervisory Preferred
• Advanced level of computer and line of business technical software skills required
• Advanced organization and planning skills necessary
• Advanced oral and written communication skills required
• Advanced interpersonal skills required
• Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

The starting pay range for this position is:

$90,400.00 - $120,300.00

Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

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Remarkable benefits:
•    Health coverage for medical, dental, vision
•    401(K) saving plan with company match AND Pension
•    Tuition assistance
•    PTO for community volunteer programs
•    Wellness program
•    Employee discounts

Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).