Commercial Auto liability, PIP/No Fault Team Leader
- medical terminology
- Excel
- Health insurance
- Pension
Not enough detail in this posting to match
POSITION SUMMARY: Under the oversight of the Area Manager, the Claims Examiner III – Team Leader reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Auto Liability and PIP/No-Fault claims from inception through resolution, within established authority and company guidelines.
In addition to maintaining an active caseload, the Team Leader provides day-to-day guidance and technical support to Claims Examiners, ensuring consistency, quality, and adherence to best practices. This role requires frequent interaction with clients, claimants, TRISTAR management, and internal staff. The Team Leader may also assist in mentoring and supporting Claims Examiners who report functionally to the role, while partnering with the Supervisor on escalations, training, and performance-related matters.
DUTIES AND RESPONSIBILITIES:
- Provides guidance, support and some supervisory directions to 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 *
- Help to establish procedures for American Arbitration Association to help reduce costs and improve process
- Effectively manages a reduced caseload of approximately 50-75 Auto files, including large No Fault PIP exposure reportable claims
- Investigates and conducts investigation in a timely manner for claims assigned.*
- Determines compensability of claims 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 set reserves within Company guidelines. Authority Limits are largerthan
those allowed for Claims Examiner I and Claims Examiner II.*
- Approves authority requests of direct repots for claims assigned and directs them to obtain authority as designated
- Settles and/or finalizes all claims assigned and obtains authority asdesignated.*
- Maintains 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 and client to resolve claims efficiently, including any injury trends or other safety related concerns. *
- Adheres to all Company policies and procedures.*
- Conduct file reviews independently.*
- Other duties asassigned.
* Essential jobfunction.
EQUIPMENT OPERATED/USED: Computer, and other officeequipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriateoffice attire when on video or attending client meetings.
Qualifications
QUALIFICATIONSREQUIRED:
Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills, andAbilities:
- Technical knowledge of coverage, statutory regulations, and medicalterminology.
- Strong Technical knowledge of NF/PIP Statutes in NY andNJ
- Analyticalskills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
- Ability to interact with persons at all levels in the businessenvironment.
- Ability to independently and effectively manage very complexclaims.
- Proficient in Word and Excel(preferred).
OtherQualifications:
- Active General Adjuster New York StateLicense
Here are some of the benefits you can enjoy in this role:
- Medical, Dental and Vision insurance
- Life & Disability Insurance
- 401(k) Plan
- Paid Holidays
- Paid time off
- Referral bonus
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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MENTALANDPHYSICALREQUIREMENTS |
- MENTALEFFORT
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- Reasoningdevelopment:
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Followone-ortwo-stepinstructions,routine,repetitivetask.
Carryoutdetailbutuninvolvedwrittenorverbalinstructions,dealwithafewconcrete variables.
Followwritten,verbal,ordiagrammaticinstructions,severalconcretevariables.
X Solvepracticalproblems;varietyofvariableswithlimitedstandardization;interpretinstructions.
Logicalorscientificthinkingtosolveproblems;severalabstractandconcretevariables.
Widerangeofintellectualandpracticalproblems;comprehendmostobscureconcepts. |
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b. Mathematicaldevelopment:
Simpleadditionalandsubtraction;copyingfigures,counting,andrecording.
Add,subtract,multiply,anddividewholenumbers.
X Arithmeticcalculationsinvolvingfractions,decimals,andpercentages.
Arithmetic,algebraic,andgeometriccalculations.
Advancedmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination.
Highlycomplexmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination requires theoretical application. |
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c. Languagedevelopment:
Abilitytounderstandandfollowverbalordemonstratedinstructions;writeidentifyinginformation; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtainbasicinformationsuchasage,occupation,andnumberofchildren;guidepeopleandprovidebasic direction.
Abilitytotranscribedictation;makeappointmentsandprocessmail;writeformlettersorroutinecorrespondence; interpret written work instructions; interview job applicants.
X Abilitytocomposeoriginalcorrespondence,followtechnicalmanuals,andhaveincreasedcontactwith people.
Abilitytoreport,write,oreditarticlesforpublication;preparedeeds,contracts,orleases,prepareand deliver lectures; interview, counsel, or advise people; evaluate technical data. |
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount offorcefrequentlyorconstantlytolift,carry,push,pull,orotherwisemoveobjects.Sedentarywork |
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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 Lightwork:
(Iftheuseofarmand/orlegcontrolsrequiresexertionofforcesgreaterthanthatforSedentaryWork and the worker sits most of the time, the job is rated for Light Work).
Mediumwork:
Heavywork:
Veryheavywork:
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b. Visualrequirementsnecessarytoperformthejob:
Far vision: clarity of vision at 20 feet ormore
X Near vision: clarity of vision at 20 inches orless
X Mid-rangevision:clarityofvisionatdistancesofmorethan20inchesandlessthan20feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Colorvision:abilitytoidentifyanddistinguishcolors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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c. Physicalactivitynecessarytoperformthejobandfrequency(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 |
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Balancing:
X Stooping:
X Kneeling:
X Crouching:
Crawling:
X Reaching:
X Standing:
X Walking:
X Pushing:
X Pulling:
Foot Motion:
X Lifting:
X Fingering:
X Grasping: |
requiredexceedsthatrequiredforordinarylocomotion.
Maintainingbodyequilibriumtopreventfallingwhenwalking,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.
Bending body downward and forward by bending spine at the waist.Thisfactorisimportantifitoccurstoaconsiderabledegreeandrequiresfull use of the lower extremities and back muscles.
Bending legs at knee to come to a rest on knee orknees.
Bendingthebodydownwardandforwardbybendinglegsandspine.Moving about on hands and knees or hands and feet. Extendinghand(s)andarm(s)inanydirection.Particularly for sustained periods of time. Movingaboutonfoottoaccomplishtasks,particularlyforlongdistances.
Usingupperextremitiestoppressagainstsomethingwithsteadyforceinorder to thrust forward, downward, or outward.
Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Using feet to pushpedals.
Raising objects from a lower to a higher position or moving objectshorizontallyfrompositiontoposition.Thisfactorisimportantifitoccursto a considerable degree and requires substantial use of the upper extremities and back muscles.
Picking,pinching,typing,orotherwiseworkingwithfingersratherthanwith the whole hand or arm as in handling.
Applyingpressuretoanobjectwiththefingersandpalm. |
Occasionally |
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Occasionally Occasionally |
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Occasionally Occasionally Occasionally Occasionally |
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Occasionally |
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Frequently |
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Frequently |
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Occasionally |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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XTalking: Expressing or exchanging ideas by means of the spoken word. Thoseactivitiesinwhichworkersmustconveydetailedorimportantspokeninstructions to other workers accurately, loudly, or quickly.
XHearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to |
Frequently
Frequently |
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makefinediscriminationsinsound,suchaswhenmakingfindadjustments on machined parts.
Feeling: Perceivingattributesofobjects,suchassize,shape,temperature,ortexture by touching with skin, particularly that of fingertips.
XRepetitive Substantialmovements(motions)ofthewrists,hands, Motion: and/or fingers. |
Frequently |
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3. WORKINGCONDITIONS
Disagreeablejobconditionstowhichtheemployeemaybeexposedandthefrequency(e.g.,continually,frequently, or occasionally) of this exposure. |
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WORKINGCONDITION ENVIRONMENTAL FACTOR |
NATURE/REASONOF EXPOSURE |
FREQUENCY |
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Dirt/Dust |
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Noise |
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Temperatureextremes |
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Dampness |
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Vibrations |
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Equipmentmovementhazard |
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Chemicals/solvents |
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Electricalshock |
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Significantworkpace/pressure |
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Odors/Fumes |
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Other(specify): |
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Commercial Auto liability, PIP/No Fault Team Leader · Tristar Insurance