Claims Examiner II, Professional Lines

Claims Examiner

Purchase, NY (Hybrid)

About TMHCC
Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Every policy we write is special, enabling our clients to do amazing things. From insuring the crops that feed us to the rock concerts that entertain us, to rescuing international travelers in trouble.
Organic growth and over 60 successful acquisitions have grown our 2023 Gross Written Premium (GWP) to over $7.5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.
What We Offer

• Competitive salary and employee benefit package
• Strong learning culture
• Growth perspectives
• 6% 401K match
• 20 days of PTO and 2 Floating Days
• Paid parental leave
• An opportunity to love what you do

Job Summary

Under general supervision, investigates and analyzes coverage for pre-litigation claims submitted under the applicable employment practices liability or other professional liability policy form. Discusses claim facts and coverage issues with insureds, defense counsel, and/or coverage counsel. Possesses critical thinking and strong oral/written communication skills.

Key Responsibilities:

Claims Examiner II is responsible for accomplishing the following assignments.

Review submitted claims for coverage and determine if a matter is covered under the applicable policy.

Key Responsibilities

• Review submitted claims for coverage and determine if a matter is covered under the applicable policy.
• Investigate claims and coverage issues.
• Complete accurate and timely coverage investigations.
• Draft actions plans, including coverage recommendations, for the approval of Claims Managers for claims.
• Independently handle claims presenting moderately complex coverage issues.
• Establish and revise claim reserves within designated authority based on claim developments and counsel liability assessments.
• Draft timely coverage determination letters, including reservation of rights and denial letters.
• Appoint defense and/or coverage counsel, as appropriate.
• Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.
• Update claims diary as needed based on activity
• Authorize settlements based on liability and other considerations within designated authority.
• Review, approve, and process payment for legal, expert/vendor invoices, and settlement.
• Conduct detailed bill reviews to ensure appropriate payment.
• Maintain a claim file by accurately documenting all communications, activity, etc.
• Communicate with agents, brokers and policyholders to obtain information necessary for processing claims.
• Attend mediations, arbitration, etc. as needed.
• Obtain and maintain claims adjuster’s licenses or other professional designations as required by the Company.

 Position Knowledge, Skills, and Requirements:

 Education

• High school diploma or the equivalent
• 4-year bachelor’s degree preferred

 Experience

• Minimum of two years of relevant and progressive professional experience as a Claims Examiner

 Other

• Possess and have ability to apply knowledge of principles, practices, and procedures
• Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
• Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment
• Experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
• Time management skills.

Schedule: Hybrid

New York Residents Only

For candidates working in person or remotely in the following location, the reasonable pay range for this specific position is $74,500 - $102,300 annually in Mount Kisco, New York.   The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, gender identity, gender expression, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws. The salary range is the range THMCC, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future, and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the pay range, the actual compensation will vary depending on the above factors as well as market and business considerations.

The Tokio Marine HCC Group of Companies offers a competitive salary and employee benefits package. We are a successful, dynamic organization experiencing rapid growth and are seeking an energetic and confident individual to join our team of professionals. The Tokio Marine HCC Group of Companies are equal opportunity, employers. Please visit www.tmhcc.com for more information about our companies.

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