Senior CL Claims Examiner

Summary

We are looking for a highly skilled and experienced Senior Commercial Lines Claims Examiner to adjudicate commercial lines claims in the jewelry insurance sector. This multi-line claim handling role is responsible for resolving property, liability, inland marine and employment practices claims that stem from our commercially insured jeweler policyholders. The Senior Claims Examiner will use their expertise to evaluate, investigate, and settle claims while ensuring compliance with industry regulations and company policies. The ideal candidate will be proactive, with a strong background in commercial insurance claims, particularly in the context of jewelry and high-value assets.

Analyzes commercial insurance claims to determine extent of insurance carrier’s liability and settles claims with claimants in accordance with policy provisions by performing the following duties.

Essential Duties and Responsibilities

• Review and evaluate commercial jewelry insurance claims in diary system to determine coverage and validity, ensuring that claims are processed in accordance with the terms and conditions of the policy. This includes claims related to property damage, theft, liability, and business interruption.
• Analyze evidence and damage documentation to assess the extent of loss or damage and make recommendations regarding claims settlements, including setting determining/recommending reserves and the proper level of compensation or repair. Approve or deny claims based on findings, company guidelines, and legal obligations.
• Identifies subrogation and salvage issues and pursues aggressively. Can assign losses in manager’s absence.
• Refers most questionable claims to investigator or to claim adjuster for investigation and settlement. Corresponds with agents and claimants to investigate questionable claims.
• Serve as a primary contact for commercial clients, agents, and internal teams, ensuring clear written and verbal communication throughout the claims process. Provide timely updates on the status of claims and address any questions or concerns regarding policy coverage, settlement decisions, or timelines.
• Travels to assist on claims settlements and investigation as outlined per departmental procedures.
• Maintain comprehensive and accurate records of claims in the company’s claims management system. Prepare and submit detailed reports on claims trends, outcomes, and settlements to management, helping identify potential areas of improvement in the claims process.
• Work closely with underwriters, legal teams, risk management, and loss prevention specialists to resolve complex claims, ensure proper documentation, and recommend policy enhancements. Identify any emerging risks or patterns that could impact the claims process or the company’s overall exposure.
• Ensure all claims are processed in accordance with state and federal insurance regulations, company standards, and industry best practices. Identify potential fraudulent claims and collaborate with the fraud department to investigate suspicious activity.
• Coordinates claims personnel activity during litigation and assists counsel in claims settlement and defense. May be required to provide testimony under oath on claims in litigation.
• Provides leadership through mentoring less experienced representatives, recommendations to management on process improvements, and demonstrates behaviors as a resource for information and willingness to share knowledge to both internal and external customers.
• Act as a mentor to junior claims examiners, offering guidance on complex cases and providing ongoing training to help develop their skills and knowledge in commercial claims handling.
• Examines claim adjustors’ reports or similar claims/precedents to determine extent of coverage and liability.
• May attend trade shows/presentations
• Other duties may be assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Leadership Responsibilities

None

Qualifications

• A minimum of two years of handling Jewelers Mutual claims as a claims examiner.
• Bachelor’s degree in Business, Insurance or related field from four-year college or university (or) five years of prior claims adjusting experience. Or equivalent combination of education and experience)
• Insurance related education including, but not limited to the completion of at least (2) AIC courses or relevant insurance designations such as CPCU or SCLA.
• Proficiency in Microsoft suite applications including Word, Excel, Outlook and PowerPoint.
• Experience in handling commercial property and liability losses is desired.
• Property/casualty insurance background and jewelry industry experience are helpful.

Certificates, Licenses, Registrations  

• Possess or obtain a Property & Casualty’s license in all applicable states.

Physical Requirements

• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear.