Claims Examiner I

CRC Group • Fort Worth, TX

4d • Onsite

About The Position

The incumbent is responsible for processing, evaluating, adjusting, and resolving non-complex, standard claims in accordance with prescribed authority and best claims practices. The position involves developing relationships with customers via telephone, investigating insurance policy coverage, determining the cause of loss, and documenting activity on each claim to reach a resolution quickly and accurately. It also requires identifying, analyzing, and resolving coverage issues according to established Company protocol, including thorough policy review and analysis of application to the individual claim. With supervisor approval, the role involves negotiating with policyholders to settle claims of limited monetary value. The Claims Examiner I will develop and direct investigative plans, conduct timely and detailed investigations, and develop thorough damage assessments. Establishing voice to voice communication within 24 hours and maintaining effective communication with the Customer at all times are crucial. The role requires consistently working within specific time limits and authority, maintaining company reputation and integrity by complying with federal and state regulations, Company protocol, and service standards, and staying current on regulations, industry activity, and trends. Additionally, the position involves partnering with SIU and Subrogation to identify questionable claims and subrogation opportunities, and assisting or preparing files for suit, trial, or subrogation.

Requirements

• Six months related, applicable experience
• Associate's degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school
• Adjusters License for states in which the Company conducts business

Nice To Haves

• Two years of related, applicable experience
• Fluency in Spanish

Responsibilities

• Develop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to come to a resolution quickly and accurately.
• Identify, analyze, and resolve coverage issues according to established Company protocol, including thorough policy review and analysis of application to the individual claim. With supervisor approval, negotiate with policyholders to settle claims of limited monetary value.
• Develop and direct investigative plans. Conduct timely and detailed investigations that include scene investigation (e.g., photos, diagrams, blueprints, maps), statements, official reports (e.g., police, fire, weather, hail), and ownership documents (e.g., tax liens, judgments, encumbrances). Identify alleged and actual damages, identify potential liable parties, recognize and address potential fraud.
• Conduct thorough damage development, leading to timely and adequate evaluations, including appraisals/estimates, business records, invoices, detailed inventory, purchase records, receipts, credit card statements, and ALE documents. Develop appropriate methods of repair/replacement, verify ownership, and apply any special limitations.
• Establish voice to voice communication within 24 hours. Maintain effective communications with the Customer at all times. Consistently work within specific time limits and authority.
• Maintain company reputation and integrity of insurance products by complying with federal and state regulations, Company protocol, and service standards. Maintain current knowledge of regulations and issues, industry activity, and trends.
• Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities. Assist or prepare files for suit, trial, or subrogation.

Benefits

• medical, dental, vision, life, disability, and AD&D insurance
• tax-advantaged savings accounts
• 401(k) plan with company match
• generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more
• restricted stock units
• deferred compensation plan

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree