Professional Liability Claims Examiner III _ Team Leader

About The Role

Professional Liability Claims Examiner III_ Team LeaderPOSITION 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

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