Claims Examiner – Spinnaker
Core
Review and approve insurance claims exceeding TPA authority, analyze coverage, manage reserves, and communicate with internal/external stakeholders to resolve claims.
Role type
Claims Examiner (Partner Programs)
Builds
Claims resolution and coverage analysis for property/casualty insurance partners
Domain
Insurance / Property & Casualty
Deliverable
client delivery
Required skills
Claims handling, coverage analysis, reserve management, policy interpretation, exposure analysis, regulatory compliance, stakeholder communication, Microsoft Office proficiency
Preferred skills
TPA/program business experience, litigated claims exposure, professional designations (AIC, ARM, CPCU)
Responsibilities
Review claims submitted by TPAs and authorize reserves/payments exceeding TPA authority; Provide guidance to TPAs on investigation and claim disposition; Assist with coverage analysis and underwriting support; Review and approve reservation of rights and coverage denial letters; Monitor TPA performance via file audits; Prepare reports for underwriters, reinsurers, and state agencies; Issue timely claim correspondence and regulatory notices; Escalate complex coverage or high-exposure matters to senior leadership.
Seniority
Mid-level, hands-on IC