25 days old

Claims Examiner

Canopius US Insurance Inc
Chicago, IL 60606
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  • Job Code
    129795473

Main Purpose:

Provides oversight of personal and commercial lines liability claims, including review and approval of claims exceeding the TPAs authority. Analyzes coverage and ensures that appropriate coverage letters are sent by the TPA. Participates in audits of assigned TPAs and ongoing review of monthly reports. Works with underwriting to provide relevant information on claims, coverage and agents.

Responsibilities:

  • Review claims submitted by TPAs and authorize reserves and payments where those amounts exceed the TPAs authority
  • Provide guidance to TPAs to ensure proper investigation and timely, equitable disposition of claims, including retention of experts and/or attorneys where needed
  • Assist TPA with coverage analysis, seeking underwriting assistance where appropriate
  • Review and approve reservation of rights and coverage denial letters to ensure accuracy and consistency in coverage analysis
  • Review claims to ensure appropriate reserve levels and that changes are made on a timely basis
  • Refer claims in excess of authority to supervisor
  • Prepare notification to underwriters and reinsurers for large or contentious claims
  • Review and approve TPA funding requests within authority
  • Participate in claim file audits to monitor TPA performance
  • Assist with preparation of reports for underwriting, agents, insureds or state agencies as needed
  • Occasional travel
  • Other duties as assigned

Skills and Experience:

  • Bachelors degree or the equivalent in related work experience; five or more years of progressive technical claim experience is required
  • Thorough technical knowledge of commercial and personal lines liability claim practices and procedures; construction defect claim experience required.
  • Thorough technical knowledge of litigated claim handling.
  • Thorough technical knowledge of commercial and personal lines coverage forms; commercial auto knowledge a plus.
  • Thorough functional knowledge of Microsoft Office tools, including Word and Excel
  • Willingness to learn and handle other lines of business based on workload and need
  • Self-starter with the desire to work in a collaborative environment and provide insight and feedback to other departments
  • Detail-oriented service professional with the ability to communicate effectively with adjusters, co-workers and clients
  • Strong analytical skills
  • Strong verbal and written communication skills
  • Good mathematical skills with ability to compute rate, ratio and percent and to draw and interpret bar graphs and tables.
  • Strong attention to detail and focused on the delivery of high quality work
  • Highly motivated, enthusiastic and structured working style


PI129795473
Posted: 2021-02-03 Expires: 2021-03-07

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Claims Examiner

Canopius US Insurance Inc
Chicago, IL 60606

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