What are the responsibilities and job description for the Claim Examiner position at Loggerhead Risk Management LLC?
About Loggerhead Risk Management LLC
Loggerhead is a property and casualty insurer that specializes in providing coverage that meets the unique needs of Florida homeowners.
We're a team of insurance professionals with customer service as our core value and we know the importance of attentively serving our policyholders. Loggerhead is powered by modern technology, guided by people who share a commitment to trust, empathy, and always doing what's right, teamwork, and flexibility.
Job description
What"s the Role?
As part of Loggerhead's Claims team, the Claim Examiner is responsible for receiving, investigating, and adjusting complex first and third-party homeowner claims, with a focus on Alternate Dispute Resolution (ADR) and Litigation. The examiner will work under minimal supervision with authority commensurate with experience.
A Day in the life could include :
Make 1st contact, set expectations with regard to coverage, limits / sublimit, deducible and
offer emergency services to Policyholders in need.
- Triage new claims and direct the appropriate adjustment method
- Initial and subsequent indemnity and expense reserving
- Report claims to ISO and evaluate loss history
- Take recorded statements of Policyholders, injured parties and other involved parties
- Prepare and send acknowledgement, status, reservation of rights, or denial letters
- Investigate coverage and / or liability and document within the claim management system
- Notate all investigative activity within the claim management system
- Follow up with other parties to secure necessary information to evaluate claims
- Investigate and evaluate injury claims and report Medicare eligible claimants for Section 111 compliance
- Collaborate with the SIU department investigating potentially fraudulent claims
- Pursue all potential subrogation / contribution recovery avenues
- Analyze all claim documentation to calculate contractual monies owed, or recommend denial of those not owed
- Issue indemnity and expense payments / recoveries in the Claim Management System
- Report known Underwriting issues for risk evaluation
- Attend mediations to resolve disputed claims
- Oversee claims throughout the appraisal process and apply coverage to panel awards prior to payment
- Timely and effectively reply to Notices of Intent to Litigate (NOIL)
- Timely and effectively work with counsel to respond to Civil Remedy Notices (CRN)
- Oversee litigated matters and direct counsel throughout the litigation lifecycle
- Seek Management guidance for issues of coverage, claims in excess of monitory authority and when investigative steps are not clear
- Identify, investigate and help resolve production errors in our Claim Management System
- Assist other team members as needed
How we position you for success :
What You"ll Need to be a Top Candidate :
Skills
Knowledge & Experience
Education & Certifications
Working Conditions :
Travel : Minimum, as required.
ADA : The above statements cover what are generally believed to be the principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of job duties.
Job Type : Full-time
Compensation & Benefits :
Additional Benefits :
Schedule :
Work Location : Remote
PI260682841