Claims Examiner- Personal Lines

USLI; Boise (ID); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A national insurance company is seeking a Claims Examiner to review coverage, conduct claims investigations, and maintain reserve accuracy. The ideal candidate will have 7+ years of relevant experience in claims handling with a preference for personal lines. Strong analytical and negotiation skills are necessary. This position offers remote work options five days a month. The successful candidate will handle responsibility for managing complex claims and collaborating with various teams effectively.

Qualifications

• Experience in personal lines claims handling is preferred.
• Multi-jurisdictional experience and advanced degrees or JD are a plus.

Responsibilities

• Confirm coverage by reviewing the first notice of loss and policy details.
• Conduct detailed investigations into claims, including liability and damages assessment.
• Retain and provide directions to independent adjusters.
• Apply statutory and case law to evaluate liability exposure.
• Maintain accurate reserves reflecting liability and damages as claims develop.
• Proactively manage claim files and negotiate settlements.
• Prepare comprehensive reserve authority requests and reinsurance reports.
• Provide updates and collaborate with underwriting, compliance, and actuarial teams.

Skills

Problem-solving skills

Communication

Negotiation expertise

Organization

Technical knowledge

Education

2+ years of relevant experience for Associate Claims Examiner

7+ years of relevant experience for Claims Examiner

Previous experience as an examiner, adjuster, paralegal, attorney, or in other transferable roles

Job description

Job Title: Claims Examiner – Personal Lines

Key Responsibilities

• Coverage review: Confirm coverage by reviewing the first notice of loss and policy details; prepare disclaimer and reservation of rights letters as necessary.
• Thorough investigation: Conduct detailed investigations into claims, including liability and damages assessment, witness interviews, scene inspections, and evidence collection.
• Independent adjusters: Retain and provide directions to independent adjusters while managing all aspects of the investigation process.
• Liability analysis: Apply statutory and case law to evaluate liability exposure and ensure joint tortfeasors contribute their fair share.
• Reserve maintenance: Maintain accurate reserves reflecting liability and damages as claims develop.
• File management: Proactively manage claim files, negotiate settlements directly with claimants or attorneys, oversee defense counsel, and ensure effective litigation management.
• Reporting: Prepare comprehensive reserve authority requests, reinsurance reports, serious loss reports, and coverage position letters.
• Cross‑team collaboration: Provide updates and collaborate with underwriting, compliance, and actuarial teams to maintain healthy products.

What You’ll Bring

• Problem‑solving skills: Analytical and creative problem‑solving capabilities with a focus on liability and damage evaluation.
• Communication: Strong oral and written communication skills to effectively interact with all stakeholders.
• Negotiation expertise: Assertive decision‑making with effective negotiation and conflict management skills.
• Organization: Strong organizational and time‑management skills to manage multiple priorities efficiently.
• Technical knowledge: Familiarity with insurance coverage, negligence law, and claim evaluation processes.

Qualifications

• 2+ years of relevant experience for Associate Claims Examiner.
• 7+ years of relevant experience for Claims Examiner.
• Previous experience as an examiner, adjuster, paralegal, attorney, or in other transferable roles.
• Personal lines experience: Experience in personal lines claims handling is preferred.
• Liability and jurisdiction knowledge: Multi‑jurisdictional experience and advanced degrees or JD are a plus.

Position affords 5 days per month to work remotely.