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Senior Claims-Specialist: Professional Liability & Allied Health

Company: James River Insurance
Location: Richmond
Posted on: September 24, 2022

Job Description:

Come grow with James River Insurance!

James River Insurance is an excess and surplus lines segment 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: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 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 three specialty property-casualty insurance and reinsurance segments: Excess and Surplus Lines, Specialty Admitted Insurance and Casualty Reinsurance. The Company tends to focus on accounts associated with small or medium-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

James River Insurance is seeking qualified candidates for it's caseload of pending Professional Liability and Allied Health insurance claims, and will consider hiring at the Senior Claims Examiner and Claims Examiner Specialist levels.

Job functions for Senior and Specialist levels include the following: Analyzing insurance claims to determine applicable coverage; Analyzing claims to determine the extent of the insured's or insurer's liability; Reviewing and evaluating damages and determining strategies for resolution; Settling claims in accordance with policy provisions and within authority level. Examiners will engage in verbal and written communication with brokers, claimants and policyholders. They will ensure that state claims handling requirements are met, and internal guidelines are followed. All Claims team members are responsible for handling claims in accordance with James River Claims Best Practices.

* The Senior Claims Examiners manage a caseload of pending insurance claims with minimal supervision.
* The Claims Specialist will function independently and will act as a resource person and consultant on issues within area of specialty.

Duties and Responsibilities

* Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
* Perform coverage, liability, and damage analysis on all claims assignments
* Investigate allegations, determine facts based on evidence and interviews
* Draft disclaimers and reservation of rights letters when coverage issues arise
* Assign limited investigations and appraisals to independent licensed professionals
* Negotiate settlements, mitigate losses, and control expenses
* Manage litigated files in accordance with Litigation Management Guidelines
* Provide technical guidance, assistance and training as needed for claims staff and other departments
* Maintain a high level of communication internally with Claims Management team and externally with Insureds, claimants, attorneys and brokers
* Work within authority limits on assignments that reflect a high degree of technical complexity and coordination
* Will be recognized as the company consultant within specialty area
* Handle special projects related to specialty area as needed

Knowledge, Skills and Abilities

* Excellent written and verbal communication skills
* Strong analytical skills
* Strong negotiation skills
* Excellent organizational skills
* Proficiency in MS Office (Word, Excel, Outlook)
* Ability to take direction from Claims Manager
* Ability to work independently with limited supervision
* Ability to work on assignments that require a high technical level of expertise due to complexity and exposure, under minimal supervision
* Ability to work successfully as an individual contributor and in a team environment
* Recognized as having a high level of expertise in claim handling and suit management
* Ability to provide technical guidance and assistance, and train less experienced Claims Examiners
* Possess demonstrated technical knowledge and skills, including product and industry, reflective of successful progress
* Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter

Experience and Education

* College degree required
* Advanced degree or law degree preferred
* Minimum of four years P&C claims handling experience, with at least 2 years focusing on Healthcare and/or Professional Liability
* Experience and proven track record in managing complex coverage issues and complex litigation
* Superior negotiation skills
* Adjuster license and/or certifications preferred



Keywords: James River Insurance, Richmond , Senior Claims-Specialist: Professional Liability & Allied Health, Healthcare , Richmond, Virginia

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