Professional Liability Claims Examiner III – Team Leader

This is a fully remote position, open to applicants in United States.

📋 Description

• Offer daily guidance, technical assistance, and work direction to Claims Examiners within the NVA Team.

• Oversee an active caseload of around 150–165 Professional Liability claims.

• Carry out prompt and thorough investigations, collecting and assessing documentation, evidence, statements, and other pertinent information.

• Analyze and interpret relevant policies, endorsements, coverage provisions, and laws to ascertain coverage, liability, damages, and claim-handling strategies.

• Engage with clients, claimants, legal representatives, service providers, vendors, and other stakeholders about claim status and resolutions.

• Set and maintain accurate reserves according to assigned authority and company/client guidelines.

• Review and authorize requests made by assigned Claims Examiners within designated authority levels.

• Negotiate, settle, and finalize claims as per the assigned authority limits.

• Maintain an efficient diary system, conduct timely case reviews, and document claim activities, evaluations, decisions, communications, and action plans.

• Report significant claim developments, coverage issues, litigation matters, exposure variations, and suggest strategies to the Claims Supervisor, Area Manager, and clients.

• Execute independent claim-file reviews to assess claim-handling quality, reserve accuracy, documentation, compliance, and adherence to action plans.

• Support the training, coaching, and mentoring of Claims Examiners, providing feedback on technical growth and work quality.

• Identify and escalate concerns regarding workflow, quality issues, client service challenges, and operational risks.

• Adhere to applicable laws, regulations, company policies, client service directives, and claim-handling procedures.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s degree in a relevant field (preferred).

• A minimum of three (3) years of related experience, or an equivalent combination of education and experience.

• Technical understanding of coverage, statutory regulations, and medical terminology.

• Strong analytical skills.

• Exceptional written and verbal communication abilities, including the capacity to explain technical details to claimants, clients, and staff.

• Ability to engage with individuals at all levels within the business environment.

• Capability to independently and effectively manage highly complex claims.

• Proficiency in Word and Excel (preferred).

• Active Independent Adjuster License for New York State.

• High School Diploma or GED is the minimum educational requirement.

🏝️ Benefits

• Competitive salary and compensation package.

• Opportunities for professional development and career advancement.

• Comprehensive health and wellness benefits.

• Flexible work schedule options.