Claims Manager (CA, Encino)
Position Description: Claims Manager analyzes coverage for complex claims submitted under the applicable policy form. The duties of a Claims Manager include discussing claim facts and coverage issues with insureds, defense counsel and/or coverage counsel, and reinsured clients, particularly on more complex matters. Duties also include managing reinsurance programs; this entails training and supervising of claims examiners. Claims Manager must possess critical thinking and strong oral/written communication skills.
Essential Duties and Responsibilities:
- Takes responsibility for training and supervising of Claim Examiners as needed
- Performs file audits and employee performance reviews and makes recommendations
- Reviewing submitted claims for coverage, and making a determination as to whether a matter is covered under the applicable policy.
- Independently investigating complex claims and coverage issues.
- Independently review examiners? action plans, including coverage recommendations, and verify appropriate action is taken.
- Establishing and revising claim reserves based on claim developments and counsel liability assessments.
- Issuing coverage determination letters, including reservation of rights and denial letters.
- Appointing and liaising with defense and/or coverage counsel, as appropriate.
- Obtaining updates from defense counsel and/or coverage counsel and/or the Insured, as appropriate.
- Authorizing settlements based on liability and other considerations within settlement authority provided by Underwriters or reinsured client.
- Conduct detailed bill reviews to ensure appropriate payment.
- Maintaining a claim file by accurately documenting all communications, activity, etc.
- Communicate with brokers or reinsured clients to obtain information necessary for processing claims.
- Attending mediations, arbitration, etc. as needed.
- Managing reinsurance programs.
- Negotiating claims-handling protocols with reinsured clients and drafting the same based on agreed to terms.
- Updating senior claims staff and the Reinsurance Team on program developments and reinsured client feedback; advising examiners of same, if appropriate.
- Attending meetings with reinsured clients.
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Chief Underwriting Officer
Michael’s main goals at NAS Insurance include developing the people he oversees, and continuing the company’s strong growth into the future through technological advancement.
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