Professional Liability Claims Examiner III _ Team Leader

Professional Liability Claims Examiner III _ Team Leader Fully Remote • Atlanta Office - Atlanta, GA 30328 Apply Overview Salary Range $100,000.00 - $112,000.00 Salary/year Level Experienced Position Type Full Time Job Shift Day Education Level High School Diploma or GED Travel Percentage None Category Admin - Clerical Apply Professional Liability Claims Examiner III_ Team Leader POSITION SUMMARY : Under the oversight of the Area Manager, the Claims Examiner III – Team Leader reports to the Claims Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority levels and company guidelines. In addition to maintaining an active caseload, the Team Leader provides day-to-day guidance, technical expertise, and operational support to Claims Examiners to promote consistency, quality, and adherence to established claims-handling practices. This position requires frequent interaction with clients, claimants, TRISTAR management, and internal staff. The Team Leader may also provide functional oversight, coaching, and mentorship to assigned Claims Examiners while partnering with the Claims Supervisor on escalated claims, training needs, workflow management, and performance-related matters DUTIES AND RESPONSIBILITIES: Provide day-to-day guidance, technical support, and work direction to Claims Examiners assigned to the NVA Team whose responsibilities are similar to those performed by the Team Leader. Manage an active caseload of approximately 150–165 Professional Liability claims in accordance with established company and client standards. Conduct timely and thorough investigations of assigned claims, including gathering and evaluating relevant documentation, evidence, statements, and other information. Review and interpret applicable policies, endorsements, coverage provisions, and relevant laws to determine coverage, liability, damages, and appropriate claim-handling strategies. Communicate professionally and effectively with clients, claimants, legal counsel, service providers, vendors, and other involved parties regarding claim status and resolution. Establish and maintain accurate reserves within assigned authority and company and client guidelines. The position may have higher authority limits than Claims Examiner I and Claims Examiner II positions. Review and approve authority requests submitted by assigned Claims Examiners within delegated authority levels and direct Claims Examiners to obtain additional authority when required. Negotiate, settle, and finalize assigned claims within delegated authority levels and obtain additional settlement authority when necessary. Maintain an effective diary system, complete timely case reviews, and thoroughly document all claim activity, evaluations, decisions, communications, and action plans. Promptly communicate significant claim developments, coverage concerns, litigation issues, exposure changes, and recommended strategies to the Claims Supervisor, Area Manager, and client. Conduct independent claim-file reviews to evaluate claim-handling quality, reserve accuracy, documentation, compliance, and adherence to established action plans. Work alongside the Supervisor with training, coaching, and mentoring Claims Examiners and provide feedback regarding technical development and work quality. Identify and escalate workflow concerns, quality issues, client-service matters, and other operational risks to the Claims Supervisor or Area Manager. Comply with all applicable laws, regulations, company policies, client service instructions, and claim-handling procedures. Perform other duties as assigned. EQUIPMENT OPERATED/USED: Computer and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire when on video or attending client meetings. Qualifications QUALIFICATIONS REQUIRED: Education/Experience : Bachelor’s degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities : Technical knowledge of coverage, statutory regulations, and medical terminology. Analytical skills. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff. Ability to interact with people at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications : Active Independent Adjuster New York State License Mental and Physical Requirements : [see separate attachment for a copy of checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS MENTAL EFFORT Reasoning development: Follow one- or two-step instructions, routine, repetitive task. Carry out detail but uninvolved written or verbal instructions, deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions, several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. PHYSICAL EFFORT Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: Exerting up to 20 pounds of force occasionally Exerting up to 10 pounds frequently Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: Exerting up to 50 pounds of force occasionally Exerting up to 20 pounds of force frequently Exerting up to 10 pounds of force constantly to move objects Heavy work: Exerting up to 100 pounds of force occasionally Exerting up to 50 pounds of force frequently Exerting up to 20 pounds of force constantly to move objects Very heavy work: Exerting in excess of 100 pounds of force occasionally Exerting in excess of 50 pounds of force constantly to move objects Exerting in excess of 20 pounds of force constantly to move objects b. Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing Balancing: X Stooping: X Kneeling: X Crouching: Crawling: X Reaching: X Standing: X Walking: X Pushing: X Pulling: Foot Motion: X Lifting: X Fingering: X Grasping: required exceeds that required for ordinary locomotion. 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. 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. Bending legs at knee to come to a rest on knee or knees. Bending the body downward and forward by bending legs and spine. Moving about on hands and knees or hands and feet. Extending hand(s) and arm(s) in any direction. Particularly for sustained periods of time. Moving about on foot to accomplish tasks, particularly for long distances. Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Using feet to push pedals. 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. Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY 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. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to Frequently Frequently make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other