Sr Claim Examiner-Liability

Location: Laguna Hills CA

Duration: 2+ Months

Job Type: Contract

Note: Top 3 Keywords: 1- Complex Claims Management / Claims Adjusting 2- Litigation & Coverage Analysis 3- Claims Investigation and Settlement Authority

Top Required Skills:

• Complex Claims Investigation & Settlement
• Policy Coverage Interpretation & Decision-Making
• Litigation, Negotiation & Subrogation Management

Must-Have Skills:

• Ability to interpret complex and unusual insurance policy coverages
• Experience managing complex claims investigations end-to-end
• Strong analytical, problem-solving, and independent decision-making skills
• Experience establishing claim reserves and authorizing payments
• Strong written, verbal, negotiation, and presentation skills
• Ability to work independently and manage multiple priorities
• Effective interpersonal skills for internal and external stakeholder interaction

Nice-to-Have Skills:

• Experience directing discovery and litigation strategy with legal counsel
• Subrogation and third-party recovery development experience
• Preparation of claims reports for clients, carriers, and management
• Professional insurance designations (IIA, AIC, AEI, CPCU)

Key Responsibilities and Duties:

• Interpret insurance policies and determine coverage applicability for complex claims
• Manage all investigative activities on complex claims, including litigation strategy with legal counsel
• Establish reserves, authorize claim payments, and ensure timely and cost-effective settlements
• Settle claims promptly and equitably within authority limits and issue company payment drafts
• Identify subrogation and third-party recovery opportunities and manage reclaim procedures
• Analyze claims activity and prepare reports for clients, carriers, and management

Requirements:

• Bachelor's degree or equivalent professional experience
• 4 8 years of experience in claims handling, investigations, or settlement roles
• Strong analytical, communication, and negotiation skills
• Ability to independently manage complex and high-value claims
• English proficiency (read, write, speak)