Claim Examiner II – Program Claims

Jobtailor; Colorado; On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking an experienced claims professional to manage moderately complex workers compensation and casualty claims across multiple jurisdictions. The role involves coverage analysis, negotiations, and coordinating with defense counsel to resolve matters efficiently.

The ideal candidate has 4+ years in insurance, strong written and verbal communication, and the ability to manage a caseload independently while collaborating with underwriters and partners. Travel may be required.

Qualifications

• Requires a college degree and professional designations are preferred.

Responsibilities

• Resolve moderate-complexity and moderate-exposure Workers Compensation claims in multiple jurisdictions.
• Investigate, negotiate, and settle non-complex policy casualty claims across various liabilities.
• Investigate and analyze coverage under primary and excess casualty insurance policies.
• Make coverage determinations and draft routine coverage correspondence.
• Communicate coverage positions to policyholders and stakeholders.
• Manage claims involving coverage litigation and nationwide litigation against insureds.
• Appoint, direct, and manage defense counsel.
• Work toward expeditious and economical claim resolution.
• Assist partners with defense counsel, bill payment, and collection issues.
• Communicate with underwriting regarding claims and significant developments.
• Summarize complex issues and develop action plans.
• Maintain guidelines, procedures, and reporting requirements.
• Implement management initiatives and action plans.
• Participate in agent-related functions and meetings.
• Support ongoing training and development of claims examiners.

Skills

Claims Investigation

Coverage Determination

Policy Casualty Claims

Contractual Obligation Analysis

Settlement Value Evaluation

Loss And Expense Reserve Setting

Insurance Coverage Litigation

Negotiation Skills

Claims Resolution

Drafting Coverage Correspondence

Education

College degree

Professional designations preferred

Job description

• Resolve moderate-complexity and moderate-exposure Workers Compensation claims in multiple jurisdictions
• Investigate, negotiate, and settle non-complex primary and excess policy casualty claims, including negligence, premises liability, commercial automobile, construction bodily injury, construction defect, product liability, and sexual assault
• Investigate and analyze coverage under primary and excess casualty insurance policies
• Make coverage determinations and draft routine coverage correspondence
• Communicate coverage positions to policyholders and other stakeholders
• Manage claims involving coverage litigation
• Manage litigation filed nationwide against insureds
• Appoint, direct, and manage defense counsel
• Work toward expeditious and economical claim resolution
• Assist internal business partners with defense counsel, bill payment, and collection issues
• Communicate with underwriting regarding claims and significant developments
• Communicate adverse case developments and pertinent professional liability product-line issues to management
• Analyze and convey summaries of complex issues and develop action plans
• Maintain internal guidelines, procedures, and reporting requirements
• Implement management initiatives, discussion, and action plans
• Participate in agent-related functions and meetings
• Support ongoing training and development of claims examiners

Requirements

• Minimum 4+ years of insurance experience required
• Experience managing, overseeing, and partnering with third-party administrators, managing general agents, and/or managing general underwriters is a plus
• College degree required and professional designations preferred
• Excellent written and oral communication skills
• Sound comprehension of insurance coverage posed by casualty liability and excess liability policies
• Ability to analyze and convey summations of complex issues both verbally and in writing; recognize alternative approaches and develop action plans
• Experience in determining contractual obligations, insurance coverage analyses, and investigations
• Insurance coverage litigation experience is a plus
• Ability to manage complex litigation, set loss and expense reserves and evaluate settlement values
• Ability to work collaboratively and as a team player
• Ability to proactively and independently manage a caseload
• Travel required as necessary (approximately 10-20%)
• US Work Authorization required
• Markel does not provide visa sponsorship for this position, now or in the future

Core Competencies

Demonstrates expertise in managing Workers Compensation claims across multiple jurisdictions, with a strong focus on insurance coverage analysis, litigation management, and effective communication with stakeholders. Proficient in developing action plans and resolving complex issues while maintaining compliance with internal guidelines and procedures.

Highest-signal resume keywords

• Workers Compensation Claims Management
• Insurance Coverage Analysis
• Litigation Management
• Excellent Written And Oral Communication
• Complex Issue Analysis

Hard Skills

• Claims Investigation
• Coverage Determination
• Policy Casualty Claims
• Contractual Obligation Analysis
• Settlement Value Evaluation
• Loss And Expense Reserve Setting
• Insurance Coverage Litigation
• Negotiation Skills
• Claims Resolution
• Drafting Coverage Correspondence

Soft Skills

• Team Collaboration
• Independent Case Management
• Problem-Solving
• Communication Skills
• Training And Development Support

Certifications & Qualifications

• College Degree
• Professional Designations Preferred

Industry Keywords

• Casualty Liability
• Excess Liability
• Third-Party Administrators
• Managing General Agents
• Managing General Underwriters
• Insurance Experience
• Claims Examiner Training
• Coverage Litigation
• Policyholder Communication
• Jurisdictional Claims Management