Claims Quality Auditor jobs in Santa Cruz, CA

 Claims Examiner III 

Summary 

Reporting to the Claims Manager and working independently with great latitude for independent action, manages an inventory of multi-line casualty claims having varying degrees of loss potential and complexity with commensurate reserving and settlement authority. Investigates, evaluates and settles claims within designated authority. Occasionally assigns and directs Independent Adjusters/Appraisers and attorneys. 

The ideal candidate would have 5-8 years carrier experience and be capable of working independently as well as collaboratively and have prior experience working remotely from a home office. 

Responsibilities

The Claims Examiner III responsibilities include but are not limited to:  

• Determines coverage(s) applicable to loss 
• Sets and maintains adequate claim reserves based on facts of case and in accordance with company policy. 
• Conducts investigation, assigning fieldwork as necessary and appropriate, in accordance with company standards. Determines liability. 
• Evaluates and pays claims within designated authority. 
• Prepares and presents verbal and written claim status reports in accordance with company policy. 
• Recommends payment, evaluates and reserves claims and reports to supervisor cases in excess of designated authority. 
• Manages legal aspects through timely assignment of litigated cases to defense counsel, and on-going evaluation of legal process and expenses. 
• Represents the company at litigation related settlement conferences, mediation, and arbitration. 
• Participates in marketing presentations and training programs as needed. 

 Required Competencies

• Requires highly technical claim management skills and an orientation for excellent customer service. 
• Ability to work in a paperless environment 
• Demonstrated track record of successfully working remotely from a home office 
• The incumbent will demonstrate a thorough knowledge of tort law, vehicle code, civil procedure, insurance policy(s) and contract(s).  
• Requires the ability to analyze and apply creative solutions to claim issues.  
• Ability to multi-task and appropriately prioritize and manage workload as assigned 
• Strong negotiating skills, excellent telephone, written and verbal communication skills are essential.  
• Requires willingness to handle smaller claims with same expertise as large, complex claims.  
• Incumbent must be aware of and follow guidelines concerning confidentiality.  
• The position communicates with legal and medical personnel, third party claimants, policyholders, producers, and senior level staff throughout the company.  
• PC literacy required; proficiency in Windows, Word, and Outlook preferred. 
• Experience in Commercial GL, Business Auto, BI is a huge plus. 
• Experience in handling Employment Practices Liability Claims, Directors and Officers Claims, or Social Service Professional Liability claims is preferred, as is a willingness to challenge oneself to handle such claims.  
• Demonstrated capability for working with a high level of independence 
• Ability to deliver results in a fast-paced environment 
• Positive approach, can-do attitude, flexibility and ability to operate with grace under pressure 
• Ability to model and uphold appropriate professional boundaries in work with member-insureds 
• Collaborate with other staff members and external partners  
• Interest and commitment to the mission of the organization 
• Commitment to inspired service 
• Communicate effectively orally and in writing 
• Travel required as necessary and must be able to be productive while traveling on business, including the ability to utilize laptops and other business tools as provided, subject to reasonable accommodation, if needed
• Must have adequate hearing to perform job tasks 
• While performing the duties of this job, the employee is regularly required to bend, reach or sit
  for up to 3 hours at a time 
• Must have adequate vision (with corrective lenses if needed) to clearly view computer screen 
• Must have adequate hearing to perform job tasks 

Experience 

• The position generally requires a minimum of five to eight years progressively more difficult claims handling experience in commercial general liability, commercial property and commercial auto. D&O experience would be preferred.  

Education 

• Four year college degree or equivalent business experience strongly preferred.  

Salary Range

$66,000 - $96,000