Claim Investigation and Loss Analysis

• Reviews and analyzes correspondence and documents primarily submitted by claimants and principals, interviews involved persons and requests additional documentation in order to determine loss and exposure.
• Documents investigation efforts in claim file and maintains relevant file documentation within SIMS claim file.
• If necessary, retains consultants or outside counsel to assist with claim investigation, defense, or salvage and indemnity aspects of claim.
• Evaluates potential sources of salvage, reimbursement and indemnification for any loss or expense that may be paid.  Pursues recovery of loss, expenses and costs in accordance with the terms of the indemnity agreement or the surety’s statutory or common law equitable rights or rights of equitable subrogation as appropriate.
• Negotiates directly with stakeholders to resolve claims, including creating secured re-payment plans, referrals to collection agencies or pursuing indemnity actions.
• Drafts reasoned determination letters and reviews recommendations with Senior Claims Attorney – Commercial Claims Manager, as appropriate. Prepares documentation for payments.
• Makes decisions regarding collateral or other indemnity or subrogation rights with assistance of Senior Claims Attorney – Commercial Claims Manager as appropriate. Coordinates with accounting on large losses or to establish cash collateral accounts. Obtains reimbursement pursuant to agreements such as collateral trust agreements. 
• Audits journal entries periodically for accuracy. 
• Makes reserve recommendations and posts reserves.
• Conducts review of entire principal account, including open bonds, principal file and involves underwriters and agents as appropriate.
• Prepares correspondence and documents for claimants, principals or third parties along with underwriters and agents, if necessary.
• Attend meetings and legal proceedings independently or in collaboration with Senior Claims Attorney – Commercial Claims Manager as appropriate in connection with claims handling process.
• Prepares and delivers presentations within the organization and participates in learning opportunities with underwriters and other internal staff.

Research and Consultation

• Seeks legal counsel or retains consultants as appropriate based on the merits of the claims.   Audits outcomes and performance to assure competence. Reviews bills for accuracy and reasonableness. Authorizes payment. 
• Stays abreast of commercial claims handling requirements in corresponding jurisdictions and attends required claim and anti-fraud training.
• Reviews and analyzes bond language, contracts, codes, statutes and case law, as applicable to specific claims.
• Stays abreast of statutory changes or other developments potentially impacting bond liability.
• Coordinates with the compliance department to obtain new licenses, if appropriate. 
• Assists claims department with projects as required from time to time.
• Provides support to key agency partners.
• Participates in mentorship and training of commercial claims examiners.

Reporting

• Prepares year end reports, as required, for files by reviewing: status of open claims, principal’s financial condition and evaluating accounts for necessary reserve changes. 
• Prepares closing memorandums summarizing the claim issues and resolution as well as losses incurred and salvage recovered. 
• Prepare claim summaries or other reports for compliance department as necessary.
• Attends industry conferences and events as appropriate.
• Assists management with monthly reporting to key agency partners as requested.
• Prepare reserve summaries with assistance of management for internal and external reporting purposes.

Education and Experience: Bachelor’s degree in Finance, Accounting, Business or Economics or equivalent work experience plus 10+ years of experience investigating and adjudicating commercial claims in the surety industry. Per the claims adjuster licensing policy, must be able to acquire within the first 30 days of emploCompetencies: Excellent written and verbal communication skills; able to work well with diverse groups of peers; communicate positive

yment and maintain an adjuster’s license in every state that requires a license. 

Essential Functions: 

This associate needs to have critical thinking skills to investigate and adjudicate claim situations. They need to be able to physically examine construction sites and claims locations. They require a high degree of detail orientation and accuracy in their work and able to communicate complex concepts in an understandable way.

Physical Demands:

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable associate’s with disabilities to perform essential functions. 

The associate’s work is performed in an office environment and requires the ability to operate standard office equipment and keyboards; and repetitive motion with substantial movements (motions) of the wrists, hands, and/or fingers. The associate frequently is required to sit walk; climb; balance and stoop, kneel, crouch, or crawl. The associate may, infrequently, be asked to lift and/or move up to 25 pounds. The associate is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures.

Working Conditions:

The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the associate is exposed to normal office working conditions that are climate-controlled. The associate would not be exposed to extreme heat cold or other workplace hazards. The noise level in the work environment is usually low.

This job description is not intended to be an exhaustive list of skills, efforts, duties, responsibilities or working conditions associated with this position. The Commercial Claims Examiner II assumes other responsibilities as assigned by the VP – Claims.