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.

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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.

Meet Some of NAS Insurance's Employees

Michael P.

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.

Kriti M.

Level Two Claims Examiner

Kriti looks into the accuracy of insurance claims to provide timely service to NAS Insurance’s many clients, ensuring everyone involved receives fair and error-free compensation.


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