Senior Claims Examiner

What You'll Do

Litigation Management: Investigate, evaluate, and resolve complex litigated property and liability claims from lawsuit assignment through final resolution, ensuring timely, efficient claim handling.
Third-Party Liability Claims: Investigate new third-party liability claims from first notice of loss, promptly contacting insureds and claimants to gather facts, assess liability, determine the claim evaluation, and set an action plan for resolution.
Claimant Negotiation: Negotiate directly with claimants and their attorneys to reach fair, well-supported settlements on third-party liability claims, applying strong negotiation skills and sound judgment within assigned authority.
Defense Counsel Partnership: Develop and execute effective, cost-efficient litigation strategies in partnership with defense counsel; prepare claim files for presentation and maintain consistent follow-up to keep cases moving toward resolution.
Trial and Hearing Participation: Attend trials, mediations, arbitrations, and depositions by phone or in person as needed, representing the company's interests and supporting favorable outcomes.
Litigated Claim Negotiation: Once a claim proceeds to litigation, contact and negotiate directly with plaintiff attorneys as appropriate, applying proven negotiation skills to reach fair, cost-effective resolutions.
Coverage Analysis: Review policy information to determine applicable coverages and make well-supported recommendations for resolving complex or disputed coverage issues in accordance with policy language and company guidelines.
Liability Determination: Evaluate liability exposures with in-depth technical expertise, applying knowledge of tort law, contracts, and coverage forms to guide claim strategy.
Reserve Accuracy: Recommend timely, accurate reserves based on claim analysis and defense counsel input, and monitor and adjust reserves as lawsuits progress.
Case Strategy and Reporting: Maintain a current diary on each claim utilizing claims software, present files to internal claims committees, and provide detailed, accurate reports for management review on major losses.
New Technology and AI: Leverage AI-driven tools and modern claims software to streamline litigation workflows, improve accuracy, and enhance the overall claims experience.
Regulatory Compliance: Ensure lawsuit handling meets all benchmarks under company guidelines, applicable statutes, and Unfair Claims Practice Acts, including timely contact, defense counsel assignment, correspondence, and complaint response.
Fraud Detection: Identify fraud indicators and recovery opportunities throughout the litigation process.
Vendor Management: Engage and monitor the work of outside vendors, including defense counsel and experts, throughout the claim adjustment and litigation process.
Mentorship: Support the claims supervisor or manager in mentoring less experienced examiners and help identify training needs across the team.
CAT Claims Support: During high CAT claim volumes, step in to support litigation and liability claims as needed.

What You'll Need

4-year college degree plus 7+ years of property, liability, and litigation claims handling experience, or a comparable combination of education and experience.
Direct experience with first and third party litigation in Florida, Texas and Louisiana. Applicable state adjuster license where required, with the ability to obtain additional state licenses as needed.
In-depth experience interpreting property damage estimates and applicable policy coverages.
Working knowledge and in-depth experience evaluating liability exposures.
Demonstrated technical expertise in claims management, including coverage, forms, contracts, and tort law.
Proven, effective negotiation skills, including experience negotiating directly with claimants and plaintiff attorneys.
Knowledge of law and insurance regulations across various jurisdictions, and the ability to stay current on legal trends affecting claim handling.
Advanced experience adopting and using new software and tools.
Proficiency in Microsoft Office products (Word, Excel, Outlook).
Insurance certifications, courses, or professional designations: A plus.
Flexibility: Able to work extended hours due to weather-related events or litigation deadlines.

• Ability to sit for extended periods of time while working at a computer, with or without reasonable accommodation
• Ability to use a computer, keyboard, mouse, and standard office equipment (e.g., phone, printer, scanner)
• Ability to view a computer screen for prolonged periods, with or without reasonable accommodation
• Ability to communicate effectively in person, by phone, and via email
• Ability to occasionally stand, walk, bend, and reach within an office environment
• Ability to lift and/or move up to 10–15 pounds occasionally (e.g., office supplies, files), with or without reasonable accommodation
• Ability to perform repetitive motions, such as typing or data entry
• Ability to maintain focus and attention while performing detailed tasks

Arbol participates in the E-Verify program to confirm employment eligibility.