Claims Examiner – Complex and Litigated Claims

  • Bloomington, IL
  • Claims

Claims Examiner – Complex and Litigated Claims

Website The James Allen Companies Inc.

Subject to a letter listing the scope of his/her authority, the Claim Examiner is an individual who is primarily
responsible for assisting in the accomplishment of the Mission of the Company and the Vision and goals of
the Claim Department through the appropriate intake, direct management and ultimate disposition of claim
related situations, occurrences, claims or suits presented to the Company on behalf of or against persons or
organizations insured by the Company. This work includes:
• receiving, collecting and assimilating information from which the determination of additional actions, if
any, are necessary and appropriate to respond to an event reported as a possible claim by an insured to the
Company or an event that becomes known to the Company that is or may become a claim under a policy of
insurance issued by or through the Company (a “Claim Event”);
• determination of the point at which coverage or coverage related services, if any, attach to such a Claim
• determination of the rights, duties and responsibilities of all parties involved in the Claim Event to whom
the Company owes a duty or from whom a duty is owed to the Company,
• creation and execution of a plan for the management of a Claim Event presented to the Company, including
the good faith execution of all duties and responsibilities of the Company or owed to the Company;
• establishing and maintaining, on behalf of the Company, an appropriate record of: information received,
decisions made and actions taken, amounts reserved and paid, communications made, the course and
conduct selected and executed, internal control of information as directed, and the ultimate disposition of a
Claim Event reported to the Company;
• accurate and timely estimation and, as necessary and appropriate, timely re-estimation of likely costs of loss
and expense allocable to such a Claim Event;
• providing effective and appropriate communication to relevant parties regarding a Claim Event;
• subject to relevant and appropriate protection of privileged, confidential and/or proprietary information,
providing timely, meaningful and accurate information regarding a Claim Event for the use of others in the
Company, both within and outside the Claim Department and, as appropriate, to parties outside the
Company, including legal counsel, investigators, adjusters, insureds, claimants and reinsurers; and
• participation, as directed, in the peer-to-peer evaluation of the quality, efficiency, effectiveness and
appropriateness of processes, procedures, systems and guidelines which effect the work of Claim
The Claim Examiner is also responsible for supporting and advancing other elements of the Mission of the
Company and the Vision and goals of the Claim Department. This work includes:
• participation, as directed, in the research, design, development and enhancement of insurance and other risk
related products, and
• other duties as assigned by the Claim Manager or the Vice President of Claims.

In this position you will investigate and develop facts involving complex claims,
most involving litigation, for local public entities in Illinois and Indiana. This
involves setting strategy and directing independent field adjusters and defense
counsel towards effective disposition of a variety of high-profile, high-exposure
claims including road design liability, employment practices, civil rights, public
officials’ liability, jail and police liability, and commercial property. You will
work with seasoned defense counsel from boutique law firms analyzing fact
situations, determining strategies and paths towards claim disposition, setting legal
budgets, and overseeing motion practice and trials in state and federal trial and
appellate courts. You will participate in the decision-making process that may
establish new legal precedent in public entity law at the state appellate level, in the
7th Federal Appellate Circuit and, potentially, in the US Supreme Court. You will
attend mediations and settlement conferences telephonically and in person,
providing authority, directing and assisting defense counsel in claims dispositions
and suit settlements.
You will also: set loss and expense reserves within authority limits; analyze and
determine insurance policy coverage and communicate your decision with
policyholders; communicate case reserves, settlement strategy and case progress
with reinsurers; communicate and work with internal Risk Management and
Underwriting staff in loss analysis and application of case-specific knowledge in
the prevention and amelioration of future claims.
Required qualifications for this unique opportunity includes experience with
complex commercial property and liability claim handling and disposition,
litigation management experience, complex coverage analysis and interpretation,
and reinsurer relationship management. Public entity claims handling,
underwriting, or risk management experience is desirable but not required

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