Company Overview

Our client is a respected third-party administrator (TPA) providing comprehensive claims management solutions to commercial clients nationwide. They are seeking a Senior Commercial General Liability Claims Examiner to handle complex liability claims with a focus on habitational and commercial real estate exposures.

COMPENSATION:

• $82,000 - $92,000/year (based on experience)
• Comprehensive benefits package including medical, dental, vision, and 401(k)
• Paid time off and paid holidays
• Fully remote work environment with flexibility

JOB QUALIFICATIONS:

• 5+ years of Commercial General Liability claims handling experience
• Demonstrated experience handling habitational and/or commercial real estate liability claims
• Prior experience working for a TPA or in a high-volume commercial claims environment preferred
• Strong litigation management and settlement negotiation skills
• Ability to independently manage a full caseload with minimal supervision

JOB RESPONSIBILITIES:

• Independently manage complex Commercial General Liability (CGL) claims, including litigated matters
• Handle claims arising from habitational and commercial real estate exposures (e.g., apartments, condos, mixed-use properties, office buildings)
• Conduct thorough investigations including coverage analysis, liability evaluation, and damages assessment
• Establish and manage reserves in accordance with client guidelines and best practices
• Coordinate with defense counsel on litigated claims, including strategy, discovery, and settlement evaluation
• Evaluate and negotiate settlements within assigned authority
• Communicate effectively with insureds, claimants, attorneys, and clients
• Ensure compliance with applicable jurisdictional regulations and client-specific service instructions
• Document claim activity accurately and timely within the claims management system
• Identify subrogation opportunities and potential fraud indicators

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1

Company Overview

Our client is a respected third-party administrator (TPA) providing comprehensive claims management solutions to commercial clients nationwide. They are seeking a Senior Commercial General Liability Claims Examiner to handle complex liability claims with a focus on habitational and commercial real estate exposures.

COMPENSATION:

• $82,000 - $92,000/year (based on experience)
• Comprehensive benefits package including medical, dental, vision, and 401(k)
• Paid time off and paid holidays
• Fully remote work environment with flexibility

JOB QUALIFICATIONS:

• 5+ years of Commercial General Liability claims handling experience
• Demonstrated experience handling habitational and/or commercial real estate liability claims
• Prior experience working for a TPA or in a high-volume commercial claims environment preferred
• Strong litigation management and settlement negotiation skills
• Ability to independently manage a full caseload with minimal supervision

JOB RESPONSIBILITIES:

• Independently manage complex Commercial General Liability (CGL) claims, including litigated matters
• Handle claims arising from habitational and commercial real estate exposures (e.g., apartments, condos, mixed-use properties, office buildings)
• Conduct thorough investigations including coverage analysis, liability evaluation, and damages assessment
• Establish and manage reserves in accordance with client guidelines and best practices
• Coordinate with defense counsel on litigated claims, including strategy, discovery, and settlement evaluation
• Evaluate and negotiate settlements within assigned authority
• Communicate effectively with insureds, claimants, attorneys, and clients
• Ensure compliance with applicable jurisdictional regulations and client-specific service instructions
• Document claim activity accurately and timely within the claims management system
• Identify subrogation opportunities and potential fraud indicators

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1

Senior Complex Claims Specialist

Job Summary
Seeking an experienced Senior Complex Claims Specialist to oversee large exposure and complex general liability, auto liability, and trucking claims. This role focuses on managing claims handled by third-party administrators (TPAs) while supporting internal stakeholders and ensuring effective resolution strategies. The position does not include direct staff management but requires oversight of the claims process and TPA performance.

Responsibilities

• Provide technical oversight on high-exposure and complex claims, ensuring timely resolution and superior outcomes.
• Collaborate with TPA staff, Claim Account Managers, underwriters, legal teams, and internal stakeholders to execute claim strategies.
• Communicate effectively with insureds and brokers, delivering exceptional customer service.
• Conduct coverage analysis, investigations, liability and damage evaluations, and reserve setting within granted authority.
• Manage litigation, vendors, settlement negotiations (including structured settlements), and overall claim resolution.
• Maintain accurate claim file documentation, coding, and diary management.
• Partner with defense and coverage counsel to develop litigation strategies, manage budgets, and review legal invoices.
• Prepare timely claim reporting and updates for management and business stakeholders.
• Participate in mediations, trials, and related proceedings.
• Ensure compliance with state adjuster licensing requirements.
• Support TPA oversight, including staff training, best practice sharing, claim audits, file reviews, and regular meetings.

Qualifications/Requirements

• Juris Doctorate degree preferred.
• Minimum of 10 years of commercial general/auto liability claims experience, including complex and large-exposure files, or equivalent law firm insurance defense/coverage experience.
• Experience with trucking, construction, or emergency services/medical professional liability claims preferred.
• Prior TPA management or oversight experience preferred.
• Strong negotiation, analytical, and problem-solving skills.
• Excellent written and verbal communication, collaboration, and interpersonal abilities.
• Proven ability to manage complex information, distill key issues, and present concise recommendations.
• Skilled in leading strategic discussions and making cost-effective decisions.
• Highly adaptable, independent, and team-oriented.
• Proficiency with Microsoft Excel, PowerPoint, and Word.
• Willingness & ability to travel up to 10% of the time.

Compensation Package

• Compensation: Between $160K–$180K (based on experience).
• Competitive benefits package, paid time off, professional development opportunities, etc.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1

Complex Claims Specialist - Miscellaneous Professional Liability (MPL)

Job Summary

Seeking a highly skilled and experienced Complex Claims Specialist to join a dynamic and innovative Claims team. This role focuses on managing mid to high-severity primary Miscellaneous Professional Liability (MPL) claims, including those involving insurance agents, property managers, tax preparers, and various consultants. As a key contributor, you will oversee all aspects of the claims and litigation process, collaborating with internal and external stakeholders to achieve optimal outcomes.

Compensation Package

• Salary Range: $125,000 - $155,000 annually
• Bonus: 10% performance-based bonus
• Benefits: Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

• Manage and resolve complex mid to high-severity MPL claims, including all phases of litigation.
• Draft complex coverage letters, including reservation of rights and denial letters, with minimal supervision.
• Analyze claim documentation and legal filings to determine appropriate resolutions.
• Lead defense strategies on litigated files, ensuring adherence to litigation best practices.
• Mentor and train team members to enhance their claims handling expertise.
• Investigate claims, negotiate settlements, and utilize alternative dispute resolution methods to achieve positive outcomes.
• Identify emerging exposures, claims trends, and suspected fraudulent claims, collaborating with the special investigations unit as needed.
• Maintain accurate and comprehensive documentation of claim files in compliance with company policies and regulatory requirements.

Qualifications/Requirements

• Minimum of 6 years of experience in Professional Liability and/or Specialty/Financial Lines claims handling.
• A Juris Doctor (JD) from an ABA-accredited law school may supplement claims handling experience.
• Proven ability to positively influence complex claims outcomes through investigation, negotiation, and litigation leadership.
• Advanced knowledge of coverage within MPL or related specialties.
• Strong understanding of the litigation process and advanced negotiation skills.
• Experience mentoring and training claims examiners.
• Excellent verbal and written communication skills.
• Advanced analytical and problem-solving abilities.
• Bachelor’s degree required; JD preferred.
• Adjuster licensing required within 90 days of employment.

#LI-BC1

Senior Claims Examiner - General Liability

Job Summary

Seeking a highly skilled and experienced Senior Claims Examiner specializing in General Liability to join a dynamic and growing claims team. This role involves managing a diverse portfolio of moderate to complex claims, including litigated files, and providing exceptional service to insureds and broker partners. The ideal candidate will have a strong background in commercial general liability claims, advanced analytical skills, and a proven ability to negotiate settlements effectively.

Compensation Package

• Salary Range: $80,000 - $125,000 per year
• Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

• Adjust and resolve moderate to complex general liability claims, including litigated files, within assigned authority.
• Accurately document claim files, ensuring compliance with company policies and regulatory requirements.
• Draft coverage letters, including reservation of rights and denial letters, with minimal supervision.
• Review and analyze claim documentation and legal filings to set timely and accurate reserves.
• Identify emerging exposures and claims trends, and escalate as necessary.
• Manage litigation effectively, including deployment and utilization of defense counsel.
• Identify and track suspected fraudulent claims in collaboration with the special investigations unit.
• Participate in claims-related projects and initiatives as needed.
• Mentor and train junior claims examiners to enhance team capabilities.

Qualifications/Requirements

• 3-5 years of claims handling experience in commercial general liability with an insurance carrier.
• Advanced knowledge of claims analysis, adjusting practices, and legal documentation standards.
• Proven ability to negotiate settlements for moderate to complex claims.
• Experience in managing litigated files and actively participating in litigation processes.
• Strong analytical, verbal, and written communication skills.
• Active insurance adjuster’s license.
• Bachelor’s degree from an accredited college or university preferred.
• A JD from an ABA-accredited law school may be considered as a supplement to claims handling experience.

#LI-BC1

Complex Claims Specialist - General Liability (Construction Defect)

Job Summary

Seeking a highly skilled and experienced Complex Claims Specialist to join a team. This senior-level role involves adjudicating complex General Liability (GL) claims, with a focus on construction defect and third-party property damage claims. The successful candidate will manage a diverse caseload, oversee litigation, and work closely with insureds, brokers, and defense counsel to ensure fair and efficient resolution of claims.

Compensation Package

• Salary Range: $115,000 - $135,000 per year
• Bonus: Competitive bonus based on personal and company performance
• Benefits: Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

• Manage a caseload of 80-100 complex GL claims, including litigated files (80%+).
• Strategize and maximize early settlement opportunities for construction defect and third-party property damage claims.
• Conduct injury evaluations and negotiations, handling claims up to policy limits (average $250k+).
• Draft and review coverage analyses, ensuring accurate documentation of claim files.
• Partner with local defense counsel to monitor litigation and drive best practices.
• Attend mediations and settlement conferences as needed.
• Assess exposures and ensure adequacy of claim reserves.
• Identify suspected fraudulent claims and collaborate with the special investigations unit.
• Actively participate in feedback loops with underwriting and actuarial teams.
• Keep senior claims management informed of key issues.

Qualifications/Requirements

• Experience:
  • 10+ years of claims handling experience within General Liability and Bodily Injury.
  • 5+ years of commercial GL experience, with a focus on construction defect claims.
  • 5-10+ years of litigation experience, actively involved in the process.
• Education:
  • Bachelor’s degree from an accredited college or university preferred.
  • A JD from an ABA-accredited law school may be considered as a supplement to claims handling experience.
• Skills:
  • Advanced knowledge of claims analysis, adjusting practices, and coverage within the specialty area.
  • Proven ability to positively influence high-severity claims outcomes through investigation, negotiation, and litigation leadership.
  • Strong analytical, verbal, and written communication skills.
  • Proven track record of mentoring and guiding others.

#LI-BC1

Senior Complex Claims Specialist - Professional Liability & Specialty Severity

Job Summary

Seeking a highly skilled and experienced Senior Complex Claims Specialist to join a dynamic and forward-thinking Claims team. This role focuses on handling high-severity primary Professional Lines claims, including Miscellaneous Professional Liability, A&E, Allied Health, and Media claims, from inception to resolution. As a key contributor, will provide technical expertise, collaborate with internal and external stakeholders, and mentor team members to ensure superior claims handling and outcomes.

Compensation Package

• Salary Range: $140,000 - $170,000 annually
• Bonus Structure: Up to 10% of base salary
• Benefits: Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

• Manage high-severity claims and draft complex technical coverage analyses and correspondence.
• Act as a subject matter expert within the team, providing guidance and mentorship to colleagues.
• Lead litigation processes, negotiate settlements, and utilize alternative dispute resolution methods to achieve positive outcomes.
• Identify and address emerging exposures and claims trends.
• Collaborate with underwriting and other business units to enhance product innovation and claims handling processes.
• Ensure compliance with company policies and regulatory requirements by maintaining accurate and detailed claim documentation.
• Develop and deliver training content for claims team members and underwriters.

Qualifications/Requirements

• Experience: Minimum of 10 years in Professional Liability and/or Specialty claims handling.
• Education: Bachelor’s degree required; JD from an ABA-accredited law school preferred.
• Proven ability to manage high-severity claims and lead litigation processes effectively.
• Expert knowledge of Professional Liability coverage and litigation processes.
• Strong analytical, negotiation, and communication skills.
• Demonstrated ability to mentor and train team members.
• Adjuster licensing required or ability to obtain within 90 days of employment.

#LI-BC1

About the Role

Seeking an experienced Auto/Bodily Injury Claims Examiner to join a growing team. In this role, you will be responsible for investigating, evaluating, and resolving auto liability and bodily injury claims on behalf of clients. This position requires strong technical claims handling skills, excellent communication, and the ability to manage claims efficiently while delivering high-quality service.

COMPENSATION

• $70,000 - $100,000/year
• Comprehensive health, dental, and vision coverage.
• 401(k) with company match.

REQUIREMENTS

• 3+ years of experience handling auto liability and bodily injury claims, preferably within a TPA or carrier environment.
• Strong knowledge of insurance policies, coverage interpretation, and state-specific claim regulations.
• Experience with medical documentation, injury evaluations, and settlement negotiations.
• Excellent verbal and written communication skills.
• Strong organizational skills with the ability to manage multiple claims simultaneously.
• Proficient in claims management systems and Microsoft Office Suite.
• Ability to work independently and as part of a collaborative team.

RESPONSIBILITIES

• Review, investigate, and analyze auto liability and bodily injury claims for coverage, liability, and damages.
• Obtain and evaluate medical records, accident reports, statements, and other relevant documentation.
• Determine appropriate claim reserves and update them throughout the life of the claim.
• Negotiate fair and timely settlements directly with claimants, attorneys, or other parties.
• Identify and pursue subrogation and contribution opportunities when applicable.
• Manage litigation, including selecting and directing defense counsel, attending mediations, and monitoring case strategy.
• Ensure compliance with client service standards, state regulations, and company policies.
• Provide clear and timely communication with insureds, claimants, clients, and brokers.
• Document claim activity thoroughly and accurately within the claims management system.
• Collaborate with management and colleagues to improve claims processes and outcomes.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1

About the Role:

Our insurance carrier client is seeking an experienced Workers' Compensation Medical Payment Specialist to join their Claims Operations team on a temporary remote assignment. This individual will play a critical role in ensuring the timely, accurate, and compliant processing of medical payments for Workers' Compensation claims while serving as a key resource for claims professionals and internal stakeholders.

The ideal candidate will possess strong knowledge of Workers' Compensation medical billing, state fee schedules, bill review processes, and payment auditing. Experience working with insurance carriers, TPAs, or bill review vendors is highly preferred.

Compensation:

• $40.00 - $50.00/hr.
• Opportunity to work with a reputable insurance carrier known for a collaborative and supportive culture
• Comprehensive benefits package including medical, dental, vision, and 401(k).
• Opportunities for career growth within a stable and respected insurance organization.

Responsibilities

• Oversee the accurate processing of Workers' Compensation medical payments in accordance with applicable state fee schedules and regulatory requirements.
• Review, audit, and reconcile medical bills to ensure payment accuracy and compliance.
• Partner with bill review vendors to monitor performance, resolve discrepancies, and maintain contractual compliance.
• Investigate and resolve payment issues, duplicate payments, billing discrepancies, and reimbursement errors.
• Evaluate daily EDI transactions for both individual and bulk medical bill payments.
• Review Explanation of Review (EOR) documentation to verify payment accuracy, tax identification information, duplicate payments, and processing errors.
• Collaborate with Claims professionals to improve medical bill processing workflows and resolve complex payment issues.
• Submit electronic reconsideration requests to bill review vendors when appropriate.
• Maintain accurate documentation and data within claims management systems.
• Respond promptly to medical billing inquiries from internal and external stakeholders.
• Assist with reporting, quality assurance initiatives, and process improvement efforts.
• Perform additional duties as assigned.

Requirements

• Minimum 2 years of experience handling Workers' Compensation medical billing, medical payment processing, bill review, or medical pricing.
• Bachelor's degree preferred. Relevant insurance industry experience may be considered in lieu of education.
• Experience working for an insurance carrier, TPA, or medical bill review vendor preferred.
• Knowledge of Workers' Compensation claims processes and medical terminology.
• Strong analytical and problem-solving skills with exceptional attention to detail.
• Ability to prioritize multiple assignments while meeting deadlines in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong customer service mindset with the ability to collaborate across departments.
• Proficiency with Microsoft Office Suite and insurance claims management systems.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1