Claims Examiner II (Remote)
About The Position
Process insurance claims for property losses based on coverage, appraisal, and verifiable damage. Interact with independent adjusters and policyholders, review claim forms and other records to determine insurance coverage, and make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations. The role may involve handling an entire claim, excluding inspection, or responsibility for a specific coverage such as Personal Property or Fair Rental Value. The position primarily handles claims involving $100,000 to $300,000 in damages, though larger or smaller claims may be assigned when necessary.
Requirements
- Excellent oral and written communication skills.
- Working experience with Microsoft Office, especially Word and Excel, is required.
- At least 2 years of property claims experience and excellent customer service.
- Certification in CEA and Fair Claims Settlement Practices.
- 3 years of total claims experience, including 2 years handling homeowners (HO) claims up to $300,000.
- 1 year of carrier experience required.
Nice To Haves
- Minimum bachelor’s degree or equivalent preferred.
Responsibilities
- Investigate, evaluate, and resolve claims, applying technical knowledge and human relations skills to promote fair and prompt settlements.
- Adjust reserves and provide reserve recommendations consistent with company policies.
- Enter claim transactions clearly and concisely.
- Examine claims inspected by independent adjusters, conduct further investigation of questionable claims, verify coverage, and issue payments to policyholders in a timely manner.
- Conduct daily diary reviews of claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations.
- Pay and process claims within the designated authority level.
- Supervise independent adjusters to ensure adherence to CFP IA Guidelines.
- Maintain compliance with Department of Insurance regulations and company policies and procedures.
- Create accurate and complete correspondence to policyholders and communicate with insureds or others involved to obtain missing information.
- Negotiate settlements promptly, reflecting actual insured losses while protecting the insurer from invalid claims.
- Confer with Claims Management and legal counsel on claims involving litigation.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
