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SalaryPosition Summary
The Large Loss/Commercial Property Examiner reviews, evaluates and processes complex residential and commercial insurance claims and makes recommendations for resolution. They will examine and authorize insurance claims investigated by independent adjusters. In addition, they will interact with independent adjusters and policyholders to oversee the review of claim forms and other records to determine insurance coverage and that payment recommendations and settlements have been made in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.
Principal Duties & Responsibilities
- Manages a caseload of high complexity residential and commercial property claims from assignment through resolution.
- Examines high complexity residential and commercial property claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims.
- Reviews and adjusts large loss reserves submitted by independent adjusters to ensure reserving activities are consistent with company policies.
- Reviews reports submitted by independent adjusters, verifies coverage, and authorizes timely payments to policyholders.
- Prepares accurate and complete professional correspondence to policyholders and others. Communicates to adjusters and/or others involved to secure missing information.
- Promptly negotiates settlements, making sure that the settlement reflects the actual insured losses while ascertaining that the insurer is protected from invalid claims.
- Leads a team of independent desk examiners as assigned during Catastrophe and /or high claims volume time periods.
- Collaborates with assigned internal personnel and/or legal counsel on claims involving litigation.
- Investigates, evaluates, and adjusts claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
- Oversee independent adjuster files to ensure they have followed CFP IA Guidelines.
- Verifies and analyzes data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures.
- Maintain compliance with the Department of Insurance and Company procedures.
- Identify fraud or illegal activity indicators and follow internal processes to refer the questionable claim to the appropriate personnel for follow up.
Knowledge and Skill Qualifications
- Bachelor’s degree or equivalent.
- 5+ years of property claims adjusting experience, including 3 to 4 years adjusting large loss & complex commercial property claims.
- Excellent oral and written communication skills.
- Working experience with MS-Office (especially Word and Excel).
- Comprehensive understanding of policy contract/statutes and claims processes.
- Certified in CEA and Fair Claims Settlement Practices preferred.
