Remote New

Senior Claims Examiner - Claims Specialist - New York Labor Law

James River Management Company
United States
Aug 09, 2025
Job Summary Under minimal supervision, the Senior Claims Examiner - Claims Specialist manages a caseload of moderate to high complexity New York Labor Law commercial insurance claims. The incumbent will review claims to analyze and determine applicable coverage, facts, liability, damages, and plan for resolution in accordance with state and company guidelines. The incumbent will be recognized as having extensive claims handling experience, including the handling of complex high exposure claims. Duties and Responsibilities Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service Perform coverage, liability, and damage analysis on all claims assignments Investigate allegations and determine facts based on evidence and interviews Draft disclaimers and reservation of rights letters when coverage issues arise Assign limited investigations and appraisals to licensed insurance professionals Manage a caseload of moderate to high complexity claims with delegated authority Manage litigated files Negotiate settlements, mitigate losses, and control expenses Participate in and attend mediations to facilitate settlements Maintain accurate documentation in claim files Prepare correspondence to all required parties involved in a claim Provide technical guidance, assistance, and training to Claims Associates and Claims Examiners Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity Maintain a passing quality assurance score on all audits and QAs Handle claims in accordance with established James River Claims Best Practices Other duties as required by management Knowledge, Skills and Abilities Expertise in claim handling and suit management Moderate to advanced knowledge of P&C insurance industry Ability to effectively assess risk Proficiency in MS Office (Word, Excel, Outlook) Excellent written and verbal communication skills Excellent organizational skills Ability to take direction from management Ability to work independently and take initiative Ability to exercise sound judgement in making critical decisions Research, analysis and problem-solving skills Strong negotiation skills Ability to build effective relationships with business partners Ability to perform effectively as part of a team Ability to organize complex information and pay close attention to detail Ability to anticipate customer needs and take initiative to meet those needs Ability to train and provide technical guidance to less experienced Claims professionals Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter Experience and Education Senior Claims Examiner High school diploma required Bachelor's Degree preferred Minimum of three years of New York Labor Law claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorney required Adjuster license and/or certifications preferred Claims Specialist High school diploma required Bachelor's Degree preferred Advanced Degree or Juris Doctorate Degree preferred Minimum of seven years of New York Labor Law claims handling experience including working with complex coverage issues, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required Adjuster license and/or certifications desired preferred #LI-KS1 #LI-Remote