Senior Claims/TPA Oversight Examiner

About you and the role:

The Senior Claims Examiner is responsible for adjusting claims and/or providing TPA oversight of the various entities under management. The role requires the ability to deal with a wide range of losses including high value and complex claims. The examiner, with minimal oversight, will lead and direct junior examiners, TPAs, and vendors. The role is responsible for performance, development, and coaching to maximize performance.

What you will be doing:

Key Accountabilities / Deliverables

• To ensure that implications for stakeholders, particularly policyholders, are given appropriate consideration in our business approach to deliver fair customer outcomes
• The adjusting of Claims either via paper or electronic presentations as required for all Syndicates and/or Group Companies
• Investigate, evaluate, negotiate, and adjudicate claims within authority and in a manner that consistently meets or exceeds our Claims Policies and Procedures
• Assist with initial triage, onboarding reviews, and scheduling of roundtable discussions
• Provide coaching, feedback, and direction on claims
• Manage the Claim Status Report documentation process
• Ensure all data is concise and accurate in electronic claim systems
• Use electronic diary systems to manage all claims
• Utilize data including loss runs to manage claims
• Setting appropriate and accurate case reserves in accordance with the company’s reserving philosophies
• Manage attorneys and negotiate and liaise with co-insurers
• Negotiating settlements as part of the market and pro-actively seek to identify and progress direct settlements solely for Enstar companies or to extend market settlements to other Enstar companies
• Reporting of claim developments and account information to management and the Litigation Legal team as applicable
• Contract interpretation, managing cedant relationships and legal representation
• Conducting inspection of records when required and negotiating equitable claim resolution
• Monitoring and oversight of external agreement parties against SLA’s and reporting any performance issues to Management
• Complying with Enstar claims handling authority levels
• Supporting and assisting Outwards, Commutation and Complex Claims teams as required
• Carry out duties within our internal policies and procedures in accordance with applicable law, rules, regulation, good governance and Enstar’s shared values, including putting clients at the heart of our business
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