Claims Examiner Property

Job Summary
This position is responsible for the review and coordination of high exposure, complex and unique claim files to ensure reserves are properly set and maintained, demands and expenses are handled appropriately, and regulatory standards are adhered to for compliance. Subject matter expert in all disciplines. Reviews lawsuits and complex coverage issues for authority to refer to counsel. Provides guidance to ACE markets for the handling, strategy, and conclusion of complex claim files. Supports the Claims business unit by providing a comprehensive level of technical support, training, and assistance. Demonstrates discretion when assessing complex and unique claims. This is the highest level non-management position in Claims.

This position is an instrumental component of the day-to-day activities within the homeowner claims unit in all regions. Examiner will be the primary lead for coordinating, directing, and overseeing complex homeowner claims activities of team staff. Key accountabilities include leadership, support, and coaching to ensure compliance with regulatory and statutory requirements, and technical and customer service Best Practices.

Job Duties

• Reviews and authorizes claim reserves and provides settlement recommendations. Provides strategic claims handling recommendations to claims personnel and counsel on the most complex, high exposure, and unique claims files. High Severity team coordination. Adapt to changing laws, statutes, case law, and Department of Insurance regulations.
• Reviews claim files to ensure completeness, timeliness, member service guidelines and reporting procedures are being adhered to for compliance and consistency.
• Provides management with recommendations and guidance regarding complex coverage issues to ensure the Exchange is protected against risk. Reviews lawsuits for authority or recommendations to settle or refer to counsel.
• Ensures accurate diaries are established and maintained and provides guidance in litigation strategy. Review legal expenses, completes large payment and decision support tool analysis to monitor expenses and severity.
• Provides strategic claims handling recommendations to the front end and field staff on the complex, unique, and files exceeding TM/UM authority or provides guidance.
• Analyzes and reports patterns and trends to management and may be involved in extra-contractual cases. Based on trends may provide training, calibrate performance, and provide recommendations and insight for improvement to claims and legal personnel. Ensures reporting procedures are adhered to.
• Conducts annual audits as directed by senior management.
• Must exercise discretion when assessing complex and unique claims. Facilitate and recommend investigative needs, values, and distinguish between allegations and facts while assessing risk. Reviews complex coverage issues and lawsuits for authority and/or recommendation to settle or refer to counsel. Provides severity, expense, and decision support tools analysis and training.
• Adapt to changing laws, statutes, case law, and Department of Insurance regulations.

Qualifications

• Bachelors Equivalent combination of education and experience Required
• 7-9 years Property claims technical experience Required
• 1-3 years Supervisory Preferred
• Advanced level of computer and line of business technical software skills required
• Advanced organization and planning skills are necessary
• Advanced oral and written communication skills required
• Advanced interpersonal skills required
• Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

Scope

• Work is accomplished without considerable direction. Exercises judgment in selecting methods, techniques, and evaluation criteria in obtaining results. Exerts significant latitude in determining objectives of assignment. Takes calculated risks with consultation from the expert.
• Works on complex issues where analysis of situations or data requires in-depth evaluation of variable factors. Constructs and may pursue alternative paths towards a solution. Exercises judgment in selecting method, techniques and evaluation criteria for obtaining results consistent with broadly defined policies and practices. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but typically six to twelve months or more to resolve.
• Functions independently within broad scope of established departmental policies/practices; generally refers specific problems to supervisor only where clarification of departmental operating policies/procedures may be required.
• This position manages/supervises people 1-5 None
• Erroneous decisions or recommendations would normally result in the inability to reach crucial organizational objectives and may have prolonged effect, as well as result in the expenditure of substantial resources.
• Represents the organization as the primary contact. Interacts with management and senior value-chain partners on matters requiring coordination across organizational lines. Achievement of objectives requires ability to influence others both internally and potentially externally.

The starting pay range for this position is:

Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

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Remarkable benefits:
•    Health coverage for medical, dental, vision
•    401(K) saving plan with company match AND Pension
•    Tuition assistance
•    PTO for community volunteer programs
•    Wellness program
•    Employee discounts

“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).