Job Description
Level: Experienced
Job Location: Involuntary - Unit 3 - Remote - All States, PA 19107
Position Type: Full TimeEducation
Level: High School Diploma or GED
Salary Range: $85,000.00 - $93,000.00 Salary/year
Travel Percentage: None
Job Shift: Day
Job Category: Admin - ClericalPOSITION SUMMARY: The Commercial Auto & General Liability Claims Examiner III independently manages a complex caseload of high-exposure California public entity commercial automobile and general liability claims, including litigated, catastrophic, and highly sensitive matters. The position is responsible for analyzing coverage, liability, damages, and legal issues; developing claim-resolution strategies; directing litigation and investigations; establishing appropriate reserves; and negotiating settlements within assigned authority.
This senior-level examiner serves as a technical resource to clients, management, and less-experienced claims professionals. The position maintains frequent contact with claimants, attorneys, defense counsel, experts, public agency representatives, and other parties involved. The Claims Examiner III provides clients with comprehensive recommendations regarding exposure, litigation strategy, reserves, settlement, and claim resolution. Position is remote/working from home.
DUTIES AND RESPONSIBILITIES:
- Independently investigate, analyze, evaluate, negotiate, and resolve complex, high-exposure commercial automobile and general liability claims.
- Manage litigated, catastrophic, sensitive, and technically complex California public entity claims from initial assignment through final resolution.
- Review and interpret policies, contracts, endorsements, coverage documents, client service instructions, and applicable laws to determine coverage and claim-handling obligations.
- Apply California public entity laws, statutes, immunities, defenses, procedures, and claims-presentation requirements to assigned matters.
- Identify and analyze complex issues involving liability, causation, damage, comparative negligence, immunities, indemnification, contribution, and risk transfer.
- Develop and implement comprehensive claim-action plans, litigation strategies, reserve recommendations, and settlement strategies.
- Establish and maintain timely, accurate, and well-supported reserves within assigned authority; promptly communicate significant exposure changes to the client and management.
- Evaluate settlement value and negotiate complex claims within delegated settlement authority.
- Prepare and present settlement recommendations for claims exceeding assigned authority.
- Direct and oversee defense counsel, investigators, appraisers, medical experts, engineers, accident-reconstruction specialists, and other outside service providers.
- Review and evaluate litigation plans, legal budgets, pleadings, discovery, expert reports, deposition testimony, and defense counsel recommendations.
- Monitor litigation progress, legal expenses, deadlines, and defense counsel performance to ensure matters are handled efficiently and in accordance with client expectations.
- Participate in mediations, mandatory settlement conferences, depositions, trials, and other legal proceedings when required.
- Conduct or coordinate field investigations and site inspections involving complex or high-exposure losses.
- Attend city council meetings, claim-review meetings, litigation strategy meetings, and client presentations in person when required.
- Prepare comprehensive loss reports addressing coverage, liability, damages, reserves, litigation strategy, settlement value, and recommended next steps.
- Present complex claim evaluations and recommendations clearly and professionally to clients, public agency representatives, management, and other stakeholders.
- Identify potential subrogation, contribution, contractual indemnity, additional insured, tender, or other risk-transfer opportunities and pursue recovery or transfer efforts at the client’s direction.
- Identify potential excess coverage, reinsurance, Medicare reporting, liens, statutory reporting, or other significant claim-related obligations and ensure timely escalation.
- Maintain complete, accurate, and timely claim-file documentation, including correspondence, evaluations, reports, negotiations, decisions, and action plans.
- Maintain an effective diary system and ensure that all claim activities, statutory deadlines, litigation dates, and client reporting requirements are completed timely.
- Communicate significant developments, emerging exposure, coverage concerns, and recommended strategies promptly to the client and management.
- Ensure assigned claims are handled in compliance with company procedures, client service instructions, applicable laws and regulations, and industry best practices.
- Serve as a senior technical resource and provide guidance to less-experienced claims examiners regarding coverage, public entity law, investigation, litigation management, claim valuation, and negotiation.
- Assist with peer file reviews, complex claim roundtables, training, quality-assurance initiatives, and process improvements as requested.
- Identify claim trends, recurring legal issues, and potential areas of client exposure and communicate observations and recommendations to management.
- Provide exceptional and responsive service to clients and other stakeholders.
- Perform other duties and special projects as assigned.
QualificationsQUALIFICATIONS REQUIRED: Education/
Experience:
- High school diploma or GED required.
- Bachelor’s degree in business, insurance, risk management, criminal justice, or a related field preferred.
- A minimum of seven years of progressively responsible experience handling commercial automobile and general liability casualty claims required.
- At least five years of direct experience independently handling complex California public entity commercial automobile and general liability claims required.
- Significant experience handling litigated, high-exposure, catastrophic, and sensitive claims required.
- An equivalent combination of relevant education, professional training, and claims experience may be considered, provided the candidate possesses the required California public entity claims experience.
- At least five years of Automobile and General Liability California Public Entity claims experience required.
- Should reside in Sacramento, CA vicinity
- Knowledge of California Public Entity claims statutes, handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and
Licensure and Location
- Current and valid California Independent Insurance Adjuster License required.
- Must maintain all licenses and continuing education requirements applicable to the position.
- Must reside in or near the Sacramento, California, area to support in-person client meetings, city council meetings, field investigations, site inspections, mediations, and other proceedings.
- Additional professional designations, such as AIC, ARM, CPCU, or SCLA, are preferred.
Knowledge, Skills, and Abilities
- Advanced knowledge of California public entity claims laws, statutes, immunities, defenses, procedures, and claims-presentation requirements.
- Advanced knowledge of commercial automobile and general liability coverage claims investigation, litigation management, damages analysis, and claim valuation.
- Demonstrated ability to independently manage complex, high-exposure, catastrophic, and litigated claims with minimal supervision.
- Ability to interpret complex policy language, contracts, endorsements, indemnity provisions, and coverage requirements.
- Ability to recognize and evaluate potential subrogation, contribution, indemnification, additional insured, and other risk-transfer opportunities.
- Advanced analytical, critical-thinking, decision-making, negotiation, and problem-solving skills.
- Thorough understanding of the civil litigation process, including pleadings, discovery, depositions, expert testimony, mediation, settlement conferences, trial preparation, and legal budgeting.
- Demonstrated ability to develop and communicate effective litigation, reserve, and settlement strategies.
- Ability to effectively manage defense counsel, experts, investigators, and other outside service providers.
- Strong presentation skills and the ability to explain complex claim matters to clients, public agency representatives, management, and other stakeholders.
- Excellent verbal and written communication skills, including the ability to prepare clear and comprehensive loss reports.
- Ability to provide technical guidance, coaching, and constructive feedback to less experienced claims professionals.
- Strong organizational and time-management skills, with the ability to prioritize competing assignments and meet statutory, litigation, and client deadlines.
- Ability to exercise sound independent judgment and maintain confidentiality when handling sensitive matters.
- Proficiency with claims-management systems and standard business applications, including Microsoft Office.
- Demonstrated professionalism, initiative, adaptability, accountability, and commitment to client service.
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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- - - X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
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- - - Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
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- - - X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
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- - - X Reaching: Extending hand(s) and arm(s) in any direction.
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- - - X Standing: Particularly for sustained periods of time.
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- - - X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
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- - - X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
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- - - X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
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- - - X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
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- - - X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
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