Claims Examiner - Complex
About The Position
The Claims Examiner is responsible for handling complex homeowners property damage claims including fire and water losses, appraisals and disputed damage claims, special investigations, and litigation. The Claims Examiner must establish rapport with the insureds and maintain relationships with agents, underwriters, contractors, restoration vendors, and experts working in a team environment with other Claims Examiners, Claims Adjusters and Claims Associates. Examiner will review policies, claims, property damage estimates, photos, police reports, inspection reports and other related reports to evaluate damage and coverage to determine amounts owed under the applicable insurance policy. Claims Examiners are responsible for requesting payments, documenting files, and preparing and issuing claim payment letters or denial letters when appropriate.
Requirements
- Bachelor’s degree or equivalent experience
- Five + years of relevant residential property & casualty work experience and/or training handling property and/or liability claims
- Gathers and analyzes information skillfully
- Works with integrity and ethics
- Ability to read, write and interpret routine correspondence and reports
- Ability to use Claims systems (PTS and Image Right)
- Experience using Xactimate and Xactanalysis
- Has TX adjusters license, other appropriate state adjuster licenses, and commitment to maintaining continuing education credits.
- Completes claims in a timely manner
- Proficiency with Microsoft Office suite (Outlook, Word, Excel, PowerPoint)
- Ability to use a personal computer and standard office equipment
- Follows policies and procedures
- Maintains confidentiality
- Communicates effectively
- Works independently, with the ability to assess workload and plan accordingly to meet competing deadlines
- Effectively manages difficult or emotional customer situations
- Writes and communicates clearly and informatively
- Cultivates environment of teamwork and collaboration
Responsibilities
- Provides excellent customer service
- Investigates, evaluates, and resolves claims, applying technical knowledge and human relations skills to affect fair and prompt resolution of claims
- Adjusts reserves and/or provides reserve recommendations
- Handles all types of claims, including homeowners, dwelling fire, tenant, condo, personal property
- Ensures proper guidelines were followed during claims process
- Reviews claims to determine if costs were reasonable
- Consults policies files to verify coverage
- Evaluates damages to ascertain compensation amount
- Enters claims payments and maintains clean, concise file documentation
- Confers with legal counsel on claims involving coverage, legal or complex matters
- Consults with policy and/or hospital records
- Examines photographs and statements
- Listens to and/or watches audio or video surveillance
- Records data and statements in reports
- Evaluates all information to determine how claims should be handled
- Negotiates with insured and/or claimant to resolve claim
- Works with attorneys, public adjusters, roofers, plumbers, and other types of contractors
- Requests payment and manages correspondence with various parties involved in the claim
Benefits
- Three (3) Medical plan options
- Two (2) Dental plan options
- A Vision plan
- Critical Illness plans
- Hospital Indemnity plans
- Accident plans
- Pre-tax savings options
- Partially employer funded Health Savings Account
- Employee Flexible Savings Accounts including healthcare, dependent care, and transportation savings options
- Company paid Basic Life and AD&D
- Short and Long-Term Disability benefits
- Voluntary Life and AD&D plans
- Traditional and Roth 401(k) plans
- Discretionary employer match for 401(k)
- Employer paid wellbeing program (Supportlinc)
- Access to on demand guided meditation and mindfulness exercises
- Mental health coaching
- Clinical care
- Online access to confidential resources including will preparation
- Free resource for year-round discounts on things like gym memberships, travel, appliances, movies, pet insurance and more (LifeBalance)
- Flexible paid vacation
- Company-paid holidays of typically nine per year
- Paid sick time
- Paid parental leave
- Identity theft program
- Travel assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
