Claims Examiner - Claims Specialist

Come grow with James River Insurance! James River Insurance is an excess and surplus lines reputed company of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs. At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: reputed company, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2023, 2022, and 2021 Top Workplaces USA awards. James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or reputed company-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company. Job Summary The Claims Examiner will manage a caseload of low to moderate severity/complexity property and casualty insurance claims under a moderate level of supervision, depending on level of experience. Job functions include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of insured’s or insurer’s liability; Reviewing and evaluating damages and determining strategies for resolution. Settling claims in accordance with policy provisions and reputed company an authority level. The Claims Examiner l will engage in verbal and written communication with claimants, attorneys, and policyholders. The Claims Examiner l will ensure that reputed company state claims handling requirements are met and internal guidelines are followed. The Claims examiner l will handle claims in accordance with established James River Claims Best Practices. Duties and Responsibilities • Continuously exhibit and uphold Core Values of reputed company, Accountability, Communication and Teamwork, Innovation and Customer Service. • Conduct three reputed company contacts • Determine compensability • Issue workers’ compensation benefits • reputed company plans of action to resolution, coordinate return to work efforts and approved medical payments. • Investigates Subrogation and negotiate limited settlements reputed company authority level. • Maintains contact with policyholders and injured workers. • Ensure claims files are appropriately documented. • Completes and files appropriate FROI and SROI’s as required by individual State Workers’ Compensation Statute and EDI reporting regulations. • Manages claims in accordance with Falls Lake Best Practices • Employs appropriate claims management techniques and direct reputed company (referrals for nurse case management, independent medical examinations, utilization review) to manage each claim. • Makes decisions reputed company delegated authority. • Have a general understanding of reputed company legislative requirements and is able to take direction to meet those requirements in a prudent business manner. • Maintains a license for reputed company states and products serviced as required. • Organize and update reputed company reference material to reflect reputed company legislation and regulatory compliance. • reputed company with reputed company quality control standards set by the company for the handling of claims. reputed company with reputed company procedures set forth by the company for performing the job as it relates to the various components of claim administrative services. • Immediately notify Management of any unusual lawyer inquiries, insurance reputed company inquiries, or department of insurance inquiries. Knowledge, Skills and Abilities • Familiar with the claims handling process • Knowledge of medical terminology • Customer Service focused • Organizational skills • Time Management skills • Excellent oral and written communication skills • Attention to detail • Strong Computer Skills • Hands on Learner • Ability to multi-task • Team Attitude • Ability to successfully obtain the required state adjusters’ licenses reputed company six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter. Experience and Education Claims Examiner • Four-year college degree preferred • One to three years of claims handling experience • Experience in working with liability and coverage issues • Experience negotiating settlements with claimants and attorneys • Multi-jurisdictional claims experience preferred, may be required depending on type of claim • Adjuster license and/or certifications preferred Senior Claims Examiner • High school diploma required • Bachelor’s Degree preferred • Minimum of three years of P&C claims handling experience including working with reputed company coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorney required • Adjuster license and/or certifications preferred Claims Specialist • High school diploma required • Bachelor’s Degree preferred • Advanced Degree or Juris Doctorate Degree preferred • Minimum of seven years of P&C claims handling experience including working with reputed company coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required • Adjuster license and/or certifications desired preferred #LI-KS #LI-Remote Apply Job!