Job Summary

Under general supervision, investigates and analyzes coverage for pre-litigation claims submitted under the applicable employment practices liability or other professional liability policy form. Discusses claim facts and coverage issues with insureds, defense counsel, and/or coverage counsel. Possesses critical thinking and strong oral/written communication skills.

Key Responsibilities:

Claims Examiner II is responsible for accomplishing the following assignments.

Review submitted claims for coverage and determine if a matter is covered under the applicable policy.

Key Responsibilities

Review submitted claims for coverage and determine if a matter is covered under the applicable policy.Investigate claims and coverage issues.Complete accurate and timely coverage investigations.Draft actions plans, including coverage recommendations, for the approval of Claims Managers for claims.Independently handle claims presenting moderately complex coverage issues.Establish and revise claim reserves within designated authority based on claim developments and counsel liability assessments.Draft timely coverage determination letters, including reservation of rights and denial letters.Appoint defense and/or coverage counsel, as appropriate.Obtain updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.Update claims diary as needed based on activityAuthorize settlements based on liability and other considerations within designated authority.Review, approve, and process payment for legal, expert/vendor invoices, and settlement.Conduct detailed bill reviews to ensure appropriate payment.Maintain a claim file by accurately documenting all communications, activity, etc.Communicate with agents, brokers and policyholders to obtain information necessary for processing claims.Attend mediations, arbitration, etc. as needed.Obtain and maintain claims adjuster’s licenses or other professional designations as required by the Company.

 Position Knowledge, Skills, and Requirements:

 Education

High school diploma or the equivalent4-year bachelor’s degree preferred

 Experience

Minimum of two years of relevant and progressive professional experience as a Claims Examiner

 Other

Possess and have ability to apply knowledge of principles, practices, and proceduresSolid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacyAdvanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneouslyKnowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environmentExperience using Microsoft Office package (Excel, Access, PowerPoint, Word)Time management skills.

Schedule: Hybrid (Three days in the office and two days working from home per week)

New York Residents Only

For candidates working in person or remotely in the following location, the reasonable pay range for this specific position is $74,500 - $102,300 annually in Mount Kisco, New York.   The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, gender identity, gender expression, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws. The salary range is the range THMCC, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future, and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the pay range, the actual compensation will vary depending on the above factors as well as market and business considerations.

The Tokio Marine HCC Group of Companies offers a competitive salary and employee benefits package. We are a successful, dynamic organization experiencing rapid growth and are seeking an energetic and confident individual to join our team of professionals. The Tokio Marine HCC Group of Companies are equal opportunity, employers. Please visit www.tmhcc.com for more information about our companies.

#CPLG-1

#LI-Hybrid