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Form of work
SalaryPOSITION SUMMARY
The Claims Examiner processes insurance claims for property or commercial losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and policyholders. They review claim forms and other records to determine insurance coverage, payment recommendations, and settlements per company practices, procedures, and Fair Claims Settlement Practices regulations.
PRINCIPAL DUTIES AND RESPONSIBILITIES
- Investigate, evaluate, and adjust large contents claims, promoting fair and prompt settlement of claims.
- Pay and processes large contents claims within designated authority level.
- Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies.
- Ensure all contents settlements have been made in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.
- Enter claim transactions, such as payments, reserves, notes, and other documentation in a clear and concise manner.
- Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in a timely manner and in accordance with Department of Insurance regulations.
- Maintain compliance with the Department of Insurance and Company policy & procedures.
- Review reports submitted by independent adjusters, verifies coverage, and authorizes timely payments to policyholders.
- Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ascertaining that the insurer is protected from invalid claims.
- Confer with management and legal counsel on claims involving litigation.
EDUCATION AND EXPERIENCE
- Bachelor’s degree or equivalent preferred.
- Excellent oral and written communication skills.
- Working experience with MS-Office (especially Word and Excel) is required.
- 2 to 5 years property claims experience and excellent customer service.
- Experienced handling contents claims.
- Comprehensive understanding of policy contract/statutes and claims processes.
- Certified in CEA and Fair Claims Settlement Practices preferred.
- Experienced in identifying fraudulent and illegal practices.
