Claims Examiner

Morristown, New Jersey
Not Specified
Apr 10, 2018
Jun 09, 2018
Job Type
Not Specified
Career Level
Not Specified
Our Accident and Health claims team currently has an opportunity available for a Claims Examiner to join them in our Morristown, NJ office, located at 44 Whippany Road. The Claims Examiner is responsible for handling and resolving complex and/or specialized assigned claims through investigation, evaluation and disposition. This position will independently operate within broad company guidelines and authority to make appropriate decisions regarding coverage and settlement of claims. Additionally, the Claims Examiner will review and process highly complex claims often involving litigation.


  1. Makes timely and appropriate contacts, determines and completes appropriate level of investigation to make determination of coverage, assess liability and determine damages for complex and specialized claims.
  2. Determines coverage, prepares coverage correspondence on appropriate claims, responds to coverage questions raised by insureds and others.
  3. Determines exposure, establishes adequate reserves and makes timely adjustments as required.
  4. Selects, assigns and directs activities of internal and external resources as required; including independent adjusters, appraisers and attorneys. Identifies questionable claims and consults with SIU for further direction as appropriate.
  5. Determines settlement value of the loss and negotiates proper settlement of claims within authority. Provides recommendations for settlement and disposition of claims exceeding authority level.
  6. Documents clearly and concisely all relevant activity on assigned files and makes recommendations for additional activity as appropriate.
  7. Anticipates and meets all customer needs (internal and external).
  8. May provide mentoring or training to other less experienced claim representatives.
  9. Stays abreast of state license requirements and participates in continuing education as required.
  10. Maintains a strong professional knowledge of regulatory and legal environments and applies this information effectively.
  • Expert claims technical knowledge, and legal climate background is essential for associated business unit.
  • Must have superior analytical, negotiation, decision making, problem solving, organizational and presentation skills. Must be a proven self-starter with strong multi-tasking and relationship management skills.
  • Must be able to communicate professionally and effectively including expert oral, written and listening skills. Must be able to work both independently and as a member of a team and have the ability to interact with diverse groups of individuals.
  • Must maintain a high level of accuracy, and provide follow-through on projects.
  • Requires the ability to maintain confidential information. Must be able to work in a fast pace and rapidly changing environment.
  • Demonstrated proficiency with computer software including Microsoft Office suite and other Claims tracking tools.
  • Must maintain strong professional knowledge of industry trends, legislative issues and the marketplace for associated line of business.
Education and Experience:
  • Bachelors degree or equivalent experience required
  • Minimum of 5-7 years of highly complex, specialty claims experience
  • Experience with breach of contract litigation a plus

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