Claims Examiner

Company:

Want to work for a company with unparalleled financial strength and stability that offers "large company" benefits with an exciting, friendly, and "small company" atmosphere? Our companies, as members of the Berkshire Hathaway group of Insurance Companies, provides opportunities for professionals interested in just that.

Job Title

Claims Examiner I, Claims Examiner II, Senior Claims Examiner I

Job Grade

B, C, D

People Management

Individual_Contributor

Job Objective

Investigate, evaluate, provide defense if appropriate, negotiate and resolve assigned property damage and bodily injury claims reported under affiliated Companies' insurance contracts, in accordance with those contracts and applicable law, within documented authority.

Essential Duties and Responsibilities

Duties are listed in order of greatest importance. Other responsibilities may be assigned.

• CLAIM INVESTIGATION: Investigate assigned claims reported under insurance contracts provided by affiliated Companies, including identification of information and documents needed to evaluate claims, assignment and direction of independent adjusters and review of public and other records and documents. Contact Insureds, Claimants and others by telephone and correspondence regarding information and documents necessary to evaluate and resolve claims, claim processes and related matters, and resolution alternatives. Comply with claims handling laws and regulations. At higher levels, may engage defense counsel as directed and monitor defense of Insureds in consultation with management as necessary or may work directly with internal legal counsel.
• COVERAGE ANALYSIS: Identify, evaluate and, in consultation with management as necessary, analyze and determine respective rights and obligations of Company, Insured, Claimants and others under insurance contracts applicable to assigned claims. Comply with laws of applicable jurisdiction. Coordinate with Legal Department on coverage, claims handling compliance, and other legal issues.
• LOSS ASSESSMENT: Analyze, evaluate, and estimate liability of Insureds and loss of Claimants/Insureds for assigned claims and identify all potential losses to which Companies' contracts of insurance apply. Identify and report potential fraud to Special Investigation Unit. Trains on and uses decision theory principles to evaluate various claim settlement scenarios in the settlement process.
• CLAIM RESERVING AND SETTLEMENT: Establish and timely modify appropriate case reserve reflecting available information regarding assigned claims. Review and approve or disapprove invoices from independent adjusters and others for allocated loss adjustment expenses. Maintain and timely review diary of assigned claims. Negotiate and resolve assigned claims within established authority or submit authority request and recommend resolution to manager.
• COMMUNICATION AND DOCUMENTATION: Prepare and maintain accurate and timely record of communications with Insureds, Claimants, and other third-parties; review, establish and modify appropriate units reflecting potential loss exposures; maintain appropriate Claim File including all required electronic and other records and provide information regarding assigned claims to manager and others as required.
• LICENSING: Obtain and maintain all required licenses and certifications; maintain current knowledge of insurance and claim management principles and practices through review of published opinions, trade periodicals and other professional literature and conferences.

Additional Duties

OTHER: Performs related duties as situation dictates such as participating in special projects, etc.

Claims Examiner I - Grade B

Fundamental Job Requirements

One or more years work experience. Uses judgment to handle basic issues and problems. Possesses beginning to working knowledge of subject matter. Works under occasional supervision, referring only unusual cases to others. Opportunity for errors may be serious and may involve loss of productivity. Routine communication requires tact with both inside and outside contacts to obtain information, cooperation, and resolve basic issues. Regularly works with confidential data. May provide part-time supervision for a limited number of employees.

Claims Examiner II - Grade C

Fundamental Job Requirements

One or more years work experience. Uses independent judgment to handle moderately complex issues and problems. Possesses comprehensive general knowledge of subject matter to make decisions on various cases working independently. Works under occasional supervision, referring only unusual cases to others. Opportunity for errors may be serious and may involve loss of productivity. Routine communication requires tact with both inside and outside contacts to obtain information, cooperation, and resolve basic issues. Regularly works with confidential data.

Senior Claims Examiner I - Grade D

Fundamental Job Requirements

Three or more years related work experience. Uses independent judgment to handle moderately complex issues and problems. Possesses comprehensive general knowledge of subject matter to make decisions on various cases working independently. Works under occasional supervision, referring only unusual cases to others. Opportunity for errors may be serious and may involve loss of productivity. Communicates with both inside and outside contacts carrying out organization policy and programs. Communication requires judgment, explanation, discussion, problem solving and considerable tact. Regularly works with confidential data.

Education

Bachelor's degree in related field or equivalent work experience.

Required Knowledge

Preferred Knowledge

• Interpretation and application of insurance contracts
• Insurance claim procedures, loss evaluation methods and claim resolution alternatives
• Insurance related courses such as AIC, CPCU

Required Skills and Abilities

• Investigation
• Evaluation and analysis
• Negotiation
• Case management
• Time management and prioritization
• Excellent oral and written communication, especially with individuals outside the Company
• Organize time and resources and handle multiple high priorities
• Research and evaluate alternatives, reach decisions, and make recommendations
• Maintain strict confidentiality
• Meet deadlines
• Work with detail with accuracy
• Work well with others

Physical Abilities

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met to successfully perform the essential functions of this job.

• Standing Occasionally 25-49%
• Walking Occasionally 25-49%
• Sitting Constantly 75-100%
• Lifting Rarely 5-24% Less than 10 lbs
• Carrying Rarely 5-24% Less than 10 lbs
• Pushing Rarely 5-24% Less than 10 lbs
• Pulling Rarely 5-24% Less than 10 lbs
• Climbing Rarely 5-24%
• Stooping Rarely 5-24%
• Kneeling Rarely 5-24%
• Crouching/Squatting Rarely 5-24%
• Reaching Rarely 5-24%
• Handling Occasionally 25-49%
• Grasping Occasionally 25-49%
• Communicating Constantly 75-100%
• Repetitive Motions - Hands Frequently 50-74%
• Driving N/A Less than 5%

Working Conditions

While performing the duties of this job, the following working conditions apply.

• Extreme Cold - less than 32 Rarely 5-24%
• Extreme Heat - greater than 100 Rarely 5-24%
• Noise - shouting to be heard Rarely 5-24%
• Exposure to dust/fumes/steam/chemicals N/A Less than 5%
• Work at heights N/A Less than 5%
• Working around moving machinery N/A Less than 5%

Travel Requirements

Estimated Amount
Less than 10%

Physical and Environmental Requirements

Office - This job primarily operates in a professional office environment routinely requiring the use of standard office equipment.

Mental, Visual or Physical Demands

Normal Demand - Flow of work and character of duties involve only normal mental attention much or all of the time.

Disclaimer Clause

The statements herein are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Regular attendance and ability to work additional time as required are essential functions. Essential job functions may change.

We want you to be involved! We offer Employee Resource Groups for volunteering, connecting with others, social gatherings, and professional development. We also regularly seek employees input through companywide surveys.

We care about your health and wellbeing! Our Wellness program is integrated into the Company culture with an online wellness portal that offers a year-round, one-stop-shop to manage and track all areas of health, our Omaha office boasts a complimentary state-of-the-art onsite fitness center, and a robust wellness program.

Benefits, Perks and more! We offer retirement and savings plan with immediate enrollment with 100% employer match up to 5%, Medical, Dental and Vision for regular, full-time employees and eligible dependents, a dedicated Learning & Development program for employees to grow personally and professionally, 100% upfront Educational Reimbursement program, subsidized downtown parking, competitive time off policies including parental leave, an Employee Assistance program and much more!