Major Case Unit Examiner

Job Description:

Job Description
The Major Case Unit Examiner is responsible for managing the investigation, evaluation, and resolution of the most complicate claims with the highest level of risk. This role may handle a combination of team-assigned claims and individual cases, often involving moderate to high exposure and complex issues related to coverage or liability, as well as suits against the company.
Key Responsibilities
 

• Oversee the management, investigation, and resolution of claims. liability, and damages, settling claims within assigned authority limits.
• Analyze and evaluate coverage, including reservation of rights, coordination with outside coverage counsel and drafting the proper communication for denial and disclaimer wherever warranted.
• Analyze and evaluate the assignment of liability for all involved parties utilizing all means to gather evidence including recorded statements, police reports, scene investigation and external vendors as needed.
• Communicate with policyholders, witnesses, and claimants to gather claim information and provide reasonable guidance and updates on the claims process.
• Identify potential fraudulent claims and refer them to the Special Investigations Unit (SIU), as well as opportunities for third-party subrogation.
• Execute the Litigation Process as outlined in the published job aide. This includes established timelines, communication and reporting as per the protocol.
• Provide recommendations on strategy and value to local claims leadership and monthly updates per established Litigation Handling guidelines.
• Ensure claim reserves are adequate and recommend adjustments for cases exceeding authority levels.
• Prepare for, and attend, trials, hearings, and conferences, providing detailed updates to local management.
• Collaborate with trial counsel and generate trial reports as well as manage expenses that are necessary for defense of the insured parties.
• Maintain financial security and confidentiality regarding claims processing and file management.
• Manage billing and practices for external legal counsel, provide recommendations regarding panel counsel and identify any concerns regarding performance and budgetary expenses.
• Contribute to special projects and mentoring initiatives as directed by management.
  Qualifications

• Advanced knowledge of coverage, liability, and complex claims handling practices.
• Familiarity with state and federal laws applicable to the adjuster’s jurisdiction.
• Comprehensive understanding of claims operations and procedures.
• Strong communication skills (written and verbal), interpersonal abilities, and proficiency in analysis, investigation, and negotiation.
• Preferred candidates will have 10+ years of claims experience with 5-7 years of directly related complex claims handling experience in a wide variety of venues.
• Typically requires a bachelor’s degree or equivalent experience with 5-7 years of directly related claims experience.
• Ability to secure necessary licensing as required by law.

This position may have in-office requirements depending on the candidate’s location and/or experience level.

Hallmark Financial Services is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.