Key Responsibilities and Required Skills for a Liability Examiner

🎯 Role Definition

The Liability Examiner is a pivotal figure within our risk management and claims operation, entrusted with the stewardship of bodily injury and property damage liability claims from their first notice to their final resolution. This role demands a unique blend of analytical rigor, investigative prowess, and expert negotiation. You will be the central point of contact, tasked with dissecting complex coverage issues, determining legal liability, and evaluating damages to ensure fair and timely outcomes. As an examiner, you are not just processing claims; you are protecting our company's financial health and upholding our promise to our policyholders by navigating challenging situations with integrity, empathy, and strategic insight.

📈 Career Progression

Typical Career Path

Entry Point From:

Claims Associate / Claims Adjuster Trainee
Paralegal (Insurance Defense)
Bodily Injury or Property Damage Adjuster

Advancement To:

Senior Liability Examiner / Complex Claims Specialist
Claims Team Lead / Supervisor
Litigation Specialist / Manager

Lateral Moves:

Risk Analyst / Risk Manager
Underwriting Consultant
Special Investigations Unit (SIU) Investigator

Core Responsibilities

Primary Functions

Manage a diverse and active caseload of moderate to high-exposure commercial and personal liability claims, including premises liability, product liability, and commercial auto claims.
Conduct prompt and thorough 360-degree investigations to establish the facts of a loss, which includes securing recorded statements from insureds, claimants, and witnesses.
Diligently gather and analyze essential evidence and documentation, such as police reports, expert reports, medical records, and wage loss information.
Perform in-depth coverage analysis by meticulously reviewing insurance policy language and applying it to the specific facts of each claim to render accurate coverage decisions.
Draft comprehensive and well-reasoned coverage letters, including reservation of rights and denial of coverage letters, in compliance with all state and federal regulations.
Evaluate legal liability by investigating the unique circumstances of each incident and applying relevant tort law and jurisdictional statutes.
Accurately assess the value of claimed damages, including bodily injury, property damage, and loss of use, to establish a reasonable settlement range.
Proactively set and maintain accurate financial reserves on all claim files, regularly reviewing and adjusting them as the claim develops to ensure financial accuracy.
Develop and execute strategic negotiation plans to achieve fair and equitable claim resolutions directly with claimants, attorneys, and other involved parties.
Make strategic, data-driven decisions to settle claims within your assigned settlement authority, or to present recommendations for settlements that exceed it.
Direct and closely manage the activities of outside defense counsel on litigated files, participating in the development of litigation strategy, budgeting, and discovery.
Attend and actively participate in legal proceedings such as mediations, arbitrations, and settlement conferences to drive files toward resolution.
Maintain a proactive and detailed claim diary system to ensure all files are handled in a timely and efficient manner, meeting all internal and statutory deadlines.
Communicate with all stakeholders, including insureds, claimants, and agents, in a clear, professional, and empathetic manner, keeping them informed of the claim's status.
Prepare detailed reports and summaries for management on high-exposure cases, claim trends, and litigation status.
Identify and refer any potentially fraudulent claims to the Special Investigations Unit (SIU) with all supporting documentation.
Partner with subrogation and recovery specialists to identify and pursue opportunities for reimbursement from responsible third parties.
Negotiate and resolve liens from various entities, including Medicare, Medicaid, and private health insurers, to facilitate final claim settlement.
Stay current on evolving case law, industry trends, and statutory changes within your assigned jurisdictions to ensure compliant and effective claim handling.
Act as a technical resource and subject matter expert, providing guidance and mentorship to less experienced team members on complex claim issues.

Secondary Functions

Support ad-hoc data requests and exploratory data analysis to identify claim trends.
Contribute to the organization's data strategy and claims handling best practices.
Collaborate with Underwriting and Risk Control departments to provide feedback on risk quality and potential hazards identified during claim investigations.
Participate in sprint planning and agile ceremonies if working within integrated tech-forward claims teams.
Assist in departmental projects and initiatives aimed at improving efficiency and customer service.

Required Skills & Competencies

Hard Skills (Technical)

Policy Interpretation: Deep expertise in interpreting and applying complex commercial and personal lines insurance policy language (CGL, Auto, Umbrella).
Legal Acumen: Strong working knowledge of tort law, civil procedure, and jurisdictional differences in liability and negligence.
Claims Software Proficiency: Experience using claims management systems like Guidewire, Duck Creek, or similar platforms for documentation, reserving, and payments.
Reserve Setting: Financial acumen to accurately analyze claim exposures and set timely and appropriate case reserves.
Medical Terminology: Ability to understand and analyze medical records, treatment plans, and billing to evaluate bodily injury claims.
Litigation Management: Proven ability to strategically manage and direct outside counsel, control litigation expenses, and drive litigated files to resolution.

Soft Skills

Negotiation and Influence: Superior ability to negotiate effectively and ethically with a wide range of individuals, including seasoned attorneys, to achieve optimal outcomes.
Analytical & Critical Thinking: Exceptional skills in analyzing complex and often conflicting information to make logical and defensible decisions.
Communication: Excellent written and verbal communication skills, with the ability to convey complex information clearly and professionally to diverse audiences.
Time Management & Organization: Meticulous organizational skills to manage a high volume of tasks and deadlines without sacrificing quality.
Empathy & Composure: The capacity to handle emotionally charged situations with empathy, professionalism, and sound judgment, especially when delivering difficult news.
Decisiveness: Confidence in making independent decisions and taking ownership of claim outcomes.

Education & Experience

Educational Background

Minimum Education:

Bachelor's Degree from an accredited college or university, or equivalent combination of education and relevant industry experience.

Preferred Education:

Bachelor's Degree.

Relevant Fields of Study:

Business Administration
Risk Management and Insurance
Pre-Law / Paralegal Studies
Criminal Justice

Experience Requirements

Typical Experience Range:

3-7 years of progressive experience handling casualty or liability claims, with a demonstrated history of handling cases of increasing complexity.

Preferred:

Experience managing a caseload that includes litigated files and claims involving significant injuries.
Possession of, or progress toward, professional insurance designations such as Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or Senior Claim Law Associate (SCLA).
A valid state-required adjuster's license may be necessary for certain jurisdictions.