Complex Claims Examiner (GL & Auto Liability )

About this Role

To handle Casualty GL and Auto Liability claims of intermediate complexity from coverage enquiry through legal liability analysis and quantum assessment, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all key internal and external stakeholders. Provide a high standard of customer service and adherence to legal and regulatory requirements.

Key Relationships: Direct reporting line to Complex Claims Team Manager

Duties and Responsibilities:-

1. Functional Responsibilities:

• Managing key claims handling enquiry; coverage determination, legal liability analysis and quantum assessment, where appropriate within authority limits and providing a consistently strong standard of customer service
• Ensuring effective vendor and litigation management on Complex claims within a personal allocation
• Broadening internal / external stakeholder communication where required
• Striving for continuous improvement on claim file handling with feedback and support through the Quality Assurance Review processes
• Contributing to maintenance of best practice procedures for Casualty GL intermediate to high value Complex claims, consistent with global best practice
• Demonstrating a high standard of technical claims competence. Demonstrate a strong standard of competence in handling intermediate to advanced complex claims in Casualty GL

2. Accountabilities:

• Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense for claims of medium to high complexity
• Consistent proactive claims handling on an ongoing basis (i.e. initial file review, investigations and liability, negotiations and settlement, and litigation management)
• Effective communication of key medium to high Complexity claims and Casualty GL portfolio messages to internal stakeholders and external stakeholders
• Financial control through consistent reserve and other financial transaction discipline
• Accurate and consistent policy interpretation against claims of intermediate to high complexity

Job Requirements:-

• Demonstrate strong communication skills, both written & verbal
• Time management – ability to manage & prioritize workload and diary management
• Ability to contribute effectively within a team environment
• Ability to work with claims stakeholders to effectively direct claims strategy
• Participate in client review and Profit Centre meetings
• Good specialist knowledge in Casualty GL and Auto Liability technical claims
• Policy language skills enabling accurate and consistent policy wording interpretation
• A strong  knowledge of legal / regulatory and litigation / procedural  requirements for their line of business
• Some experience in negotiation, mediation, arbitration and ADR skills. Strong experience in negotiating on intermediate to high complex claims and knowledge and experience in mediation, arbitration and Alternative Dispute Resolution
• Experience in effectively following up on recommendations from technical claims audits and continuous claim handling improvement