Professional Liability Claims Examiner III

TRISTAR RISK MANAGEMENT; Irving (TX); On-site; USD 80,000 - 95,000; Full time

Job summary

Paycom - ATS is seeking an experienced Claims Examiner III to manage professional liability claims from inception to resolution. You will review policy information, determine coverage, and coordinate with clients, counsel, and investigators.

Remote work is supported, with a focus on accurate reserves and timely settlements. The role requires a Bachelor’s degree (preferred) or equivalent, 5+ years in claims, and an active NY Independent Adjuster license.

Qualifications

• Bachelor’s degree or related field preferred; 5+ years related experience, or equivalent.
• Active NY Independent Adjuster license is required.
• Strong written and verbal communication; proficient in Word and Excel.
• Experience handling professional liability claims and litigation support.

Responsibilities

• Review, process and conclude assigned claims including investigation and evaluation of professional liability claims.
• Review and interpret policies, coverage determinations.
• Oversee outside investigative services and coordinate with clients and counsel.
• Maintain an ongoing diary and case documentation.
• Assess exposure and establish reserves and settlement recommendations.
• Prepare loss reports detailing liability and damages.
• Coordinate subrogation and/or risk transfer recovery efforts when applicable.
• Document all communications and actions in the claim file.
• Provide outstanding service to the client.
• Assist Supervisors with tasks and special projects.

Skills

Technical knowledge

Analytical skills

Communication skills

Interaction with stakeholders

Independent claims management

Word & Excel

Education

High School Diploma or GED

Bachelor’s degree preferred

Tools

Active NY Independent Adjuster License

Job description

Job Details: Level: Experienced, Job Location: Dallas - Irving, TX, Position Type: Full Time, Education Level: High School Diploma or GED, Salary Range: $80000.00 - $95000.00Salary/year, Travel Percentage: None, Job Shift: Day, Job Category: Admin - Clerical, POSITION SUMMARY: Under the oversight of the Area Manager, the Claims Examiner III reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority and company guidelines. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

DUTIES AND RESPONSIBILITIES

• Review, process and conclude assigned claims including investigation and evaluation of professional liability claims.
• Review and interpret policies, coverage determination.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department with requested tasks or special projects.
• Other duties as assigned.

Position is remote/working from home.

EQUIPMENT OPERATED/USED: Computer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire when on video or attending client meetings.

Qualifications:

QUALIFICATIONS REQUIRED

Education/Experience: Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills, and Abilities

• Technical knowledge of coverage, statutory regulations, and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
• Ability to interact with people at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications

• Active Independent Adjuster New York State License

Mental and Physical Requirements

[see separate attachment for a copy of checklist of mental and physical requirements]

MENTAL AND PHYSICAL REQUIREMENTS

MENTAL EFFORT

Reasoning development:

Follow one- or two-step instructions, routine, repetitive task.

Carry out detail but uninvolved written or verbal instructions, deal with a few concrete variables.

Follow written, verbal, or diagrammatic instructions, several concrete variables.

X Solve practical problems; variety of variables with limited standardization; interpret instructions.

Logical or scientific thinking to solve problems; several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development:

Simple additional and subtraction; copying figures, counting, and recording.

Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination requires theoretical application.

b. Language development:

Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

PHYSICAL EFFORT

Physical activity required to perform the job:

Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

X Light work:

Exerting up to 20 pounds of force occasionally

Exerting up to 10 pounds frequently

Exerting a negligible amount of force constantly to move objects

(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

Medium work:

Exerting up to 50 pounds of force occasionally

Exerting up to 20 pounds of force frequently

Exerting up to 10 pounds of force constantly to move objects

Heavy work:

Exerting up to 100 pounds of force occasionally

Exerting up to 50 pounds of force frequently

Exerting up to 20 pounds of force constantly to move objects

Very heavy work:

Exerting in excess of 100 pounds of force occasionally

Exerting in excess of 50 pounds of force constantly to move objects

Exerting in excess of 20 pounds of force constantly to move objects

b. Visual requirements necessary to perform the job:

Far vision: clarity of vision at 20 feet or more

X Near vision: clarity of vision at 20 inches or less

X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet

Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are

Color vision: ability to identify and distinguish colors

Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point

2. PHYSICAL EFFORT (cont.)

FREQUENCY

c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands. Body agility is emphasized. This factor is important if the amount and kind of climbing

Balancing:

Stooping:

Kneeling:

Crouching:

Crawling:

Reaching:

Standing:

Walking:

Pushing:

Pulling:

Foot Motion:

Lifting:

Fingering:

Grasping:

required exceeds that required for ordinary locomotion.

Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

Bending legs at knee to come to a rest on knee or knees.

Bending the body downward and forward by bending legs and spine. Moving about on hands and knees or hands and feet.

Extending hand(s) and arm(s) in any direction. Particularly for sustained periods of time.

Moving about on foot to accomplish tasks, particularly for long distances.

Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

Using feet to push pedals.

Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

Applying pressure to an object with the fingers and palm.

Occasionally

Occasionally Occasions

Occasionally Occasions Occasions Occasionally

Occasionally

Occasionally

Frequently

Frequently

Occasionally

2. PHYSICAL EFFORT (cont.)

FREQUENCY

X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.

Frequently

Frequently

Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers.

Frequently

3. WORKING CONDITIONS

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.

WORKING CONDITION ENVIRONMENTAL FACTOR

NATURE/REASON OF EXPOSURE

FREQUENCY

Dirt/Dust

Noise

Temperature extremes

Dampness

Vibrations

Equipment movement hazard

Chemicals/solvents

Electrical shock

Significant work pace/pressure

Odors/Fumes

Other (specify):