[Remote] Sr Claims Examiner - MSI

Note: The job is a remote job and is open to candidates in USA. The Baldwin Group is a leading MGA specializing in insurance solutions. They are seeking a Senior Claims Examiner to manage complex third-party claims involving bodily injury and property damage, ensuring superior service and effective communication with stakeholders.

Responsibilities

• Directly handles third-party claims involving complex and severe bodily injury or property damage from initial assignment through to resolution of claim, including negotiating settlements.
• Evaluates and analyzes insurance policies in order to make coverage determinations.
• Drafts Reservation of Rights letters and coverage disclaimers as warranted.
• Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations.
• Investigates claims to determine validity and the potential for liability against insureds.
• Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves.
• Works a claim load efficiently and independently with little to no supervision.
• Sets timely file reserves in compliance with company’s reserving philosophy and continues to evaluate pending reserves throughout the life of the claim.
• Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary.
• Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors’ performance while controlling expense costs.
• Drafts reports for large losses and reports to Leadership as required.
• Evaluates, negotiates and determines settlement values in settlement of claims.
• Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties.
• Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner.
• Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines.
• Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners.
• Responsible for monitoring and completing assigned claims inventory.
• Acquires and maintains multiple state adjuster’s licenses and maintains continuing education requirements.
• Develops and maintains relationships with external and internal stakeholders.
• Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable.
• Identifies opportunities for subrogation and ensures recovery interests are protected.
• Acts as a mentor for less experienced Claims Examiners.
• Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file.
• Assists with special projects when required.

Skills

• Bachelor’s degree or equivalent work experience
• 10+ years of casualty claims adjusting experience
• Must have a State Adjuster License(s) (California, Florida licenses are desirable) with a willingness to expand licenses as needed.
• Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence.
• Strong organizational and time management skills.
• Strong writing skills.
• Excellent analytical, investigative, and negotiation skills.
• Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies.
• First-Party Property experience is a plus
• Insurance designations preferred

Company Overview

• The Baldwin Group is an advisory firm that delivers insurance, risk mitigation, and wealth management solutions for businesses. It is a sub-organization of The Baldwin Group. It was founded in 2011, and is headquartered in Tampa, Florida, USA, with a workforce of 1001-5000 employees. Its website is https://baldwin.com.

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