Claims Examiner - Complex

CITON Claims Solutions•Irving, TX

9d•Onsite

About The Position

Join our team as a Claims Examiner - Complex! Are you a detail-oriented claims professional with a passion for helping others? We’re looking for a Desk Adjuster to work in our office located in Melbourne, Florida or Dallas, Texas. In this role, you’ll play a pivotal part in investigating, evaluating, and resolving insurance claims, ensuring fair and efficient processing in line with policy terms and company guidelines. In this role you will be handling complex litigated claims, mediations, appraisals, and claims involving other 3rd parties.

Requirements

Minimum of 7+ years in a claim adjusting role, with direct experience handling litigated claims, mediations, appraisals, and claims involving other 3rd parties.
Experience handling Florida property claims is strongly preferred.
Proficiency with CMS, Microsoft Suite of products, strong analytical, investigative, and problem-solving skills; solid understanding of legal concepts surrounding liability claims.
Valid adjuster’s license in home state and Florida required.
Strong understanding of insurance policies, coverage evaluation, claim investigation, and dispute resolution throughout the life of a file.
Should be able to demonstrate advanced understanding of all issues related to liability claims including state regulations, case law, and statutes.
Excellent negotiation and communication skills, with proven ability to manage complex conversations and drive fair claim resolution with insureds, vendors, attorneys, and public adjusters.

Responsibilities

Assess and analyze submitted claims documentation to determine validity and coverage.
Communicate with policyholders, witnesses, and other involved parties to collect relevant details for claims evaluation.
Create detailed reports and maintain comprehensive notes to support claims assessments.
Review insurance policies to determine applicable coverage and assess liability.
Submit thorough reports with findings and well-supported recommendations for claim settlements.
Work with policyholders and third parties to negotiate settlements that ensure fair and just outcomes.
Handle disputes professionally and efficiently, ensuring favorable resolutions.
Foster transparent and professional communication with policyholders and all stakeholders throughout the claims process.
Partner with internal teams, including underwriters and legal advisors, to resolve complex claims.
In all claims processes, comply with state and federal regulations and company policies.
Provide critical support for claims management efforts during disaster events as needed.