POSITION SUMMARY: Under minimal supervision, the Claims Examiner III Team Leader reports to the Claim Supervisor and/or Area Manager and manages all aspects of Auto Liability and Property claims handling from inception to conclusion within established authority and guidelines.

 

This position requires considerable interaction with clients, claimants on the phone, TRISTAR management, other TRISTAR staff, and Claims Examiners, and Claims Examiners reporting directly to the Claims Examiner III Team Leader.

 

DUTIES AND RESPONSIBILITIES:

 

Effectively manages a caseload of 75-100 Auto Liability and Property files, including

 

large exposure reportable claims. *

 

Initiates and conducts investigations in a timely manner for claims assigned. * Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company and client guidelines. *

 

Communicate with clients, claimants, providers, and vendors regarding claims issues. * Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. *

 

Settles and/or finalizes all claims assigned and obtains authority as designated. * Maintains a diary system for case review and documents file to reflect the status and work being performed on the file assigned. *

 

Communicates appropriate information promptly to the Area Manager client to resolve claims efficiently, including any injury trends or other safety-related concerns. * Provides overall supervision, guidance, and support with 2-3 direct reports, TRISTAR adjusters on the Tower/Venture Leasing Team, whose duties are similar to those outlined above for claims they are assigned by the Claims Examiner III Team Leader * Adheres to all Company policies and procedures. *

 

Conducts file reviews independently. * Other duties as assigned.

 

* Essential job function.

 

EQUIPMENT OPERATED/USED: Computer and other office equipment.

 

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire when on video or attending client meetings

QUALIFICATIONS REQUIRED:

 

Education/Experience degree in related field (preferred); three (3) or more years

 

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 the ability to convey technical details to claimants, clients, and staff.

 

Ability to interact with persons 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 General Adjuster New York State License

 

Mental and Physical Requirements: [see separate attachments for a copy of the checklist of mental and physical requirements}

 

MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORTa. Reasoning development:Follow one- or two-step instructions, routine, repetitive task.Carry out detail but uninvolved written or verbal instructions, deal with a few concrete variables.Follow written, verbal, or diagrammatic instructions, several concrete variables.Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development:Simple additional and subtraction; copying figures, counting, and recording.

X Solve practical problems; variety of variables with limited standardization; interpret

 

instructions.

 

 

Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages.Arithmetic, algebraic, and geometric calculations.Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination requires theoretical application. c. Language development:Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.X Ability to compose original correspondence, follow technical manuals, and have increasedcontact with people.Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORTa. Physical activity required to perform the job:Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.X Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds frequentlyc. Exerting a negligible amount of force constantly to move objects(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objects

 

Heavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objectsVery heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objects b. Visual requirements necessary to perform the job:Far vision: clarity of vision at 20 feet or moreX Near vision: clarity of vision at 20 inches or lessDepth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually areColor vision: ability to identify and distinguish colorsField of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g.,continually, frequently, or occasionally):Climbing: Ascending or descending ladders, stairs, scaffolding,ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.X Stooping: Bending body downward and forward by bending spine atthe waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. OccasionallyOccasionally

X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20

 

feet

 

 

X Kneeling: Bending legs at knee to come to a rest on knee or knees.X Crouching: Bending the body downward and forward by bending legs and spine.Crawling: Moving about on hands and knees or hands and feet.X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time.X Pushing: Using upper extremities top press against something withsteady force in order to thrust forward, downward, or outward.FootMotion: Using feet to push pedals.X Lifting: Raising objects from a lower to a higher position or movingobjects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.X Fingering: Picking, pinching, typing, or otherwise working with fingersrather than with the whole hand or arm as in handling.X Grasping: Applying pressure to an object with the fingers and palm. OccasionallyOccasionallyOccasionallyOccasionallyOccasionallyOccasionallyFrequentlyFrequentlyOccasionally

X Walking: Moving about on foot to accomplish tasks, particularly for

 

long distances.

 

X Pulling: Using upper extremities to extent force in order to drag,

 

haul, or tug objects in a sustained motion.

 

2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spokenword. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.Feeling: Perceiving attributes of objects, such as size, shape, FrequentlyFrequently

 

temperature, or texture by touching with skin, particularly that of fingertips.X Repetitive Substantial movements (motions) of the wrists, hands,Motion: and/or fingers. Frequently 3. WORKING CONDITIONSDisagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITIONENVIRONMENTALFACTOR NATURE/REASONOF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify):