Senior Claims Examiner

POSITION SUMMARY: The Sr. Claims Examiner is responsible for demonstrating a sophisticated understanding of insurance principles, claims investigation, damage evaluation, and resolution of property claims, creating a positive customer experience. A Sr. Claims Examiner provides prompt, cost effective and efficient examination, investigation, evaluation, and payment of complex insurance claims by exercising independent decision-making skills and judgment within designated authority. This position will generally work with commercial claims with some high complexity residential claims. This role can be performed remotely.

ESSENTIAL FUNCTIONS:

The following are the usual, basic and essential functions of the Sr. Claims Examiner position. However, this job description does not preclude the performance of other duties by the incumbent. These functions are not to be construed as an exhaustive list of all responsibilities, duties, and skills required:

• Demonstrates a customer centric attitude
• Analyzes and manages claims by verifying coverage and investigating and gathering pertinent information to determine the exposure on the claim
• Maintains well-developed action plans for an appropriate and timely resolution in accordance with established policies and procedures
• Recognizes and properly addresses coverage issues, potential fraud, and subrogation potential
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim
• Conducts detailed damage and bill reviews and controls claim expenses
• Pays and processes claims within designated authority level or denies payments where no coverage, liability, or compensability exists
• Enters claim payments and reserves on claims on computer system, inputting concise and accurate file documentation
• Communicates decisions in a clear and professional manner
• May provide training, coordination, and investigation of potential fraudulent activity for the Association.

REQUIRED EDUCATION AND EXPERIENCE:

• Bachelor’s degree or 6+ years of relevant work experience
• Texas Adjuster License
• This position requires the Sr. Claims Examiner to obtain the Associate in Claims designation within two years of the date of hire/promotion, or the Chartered Property Casualty Underwriter designation within three years of the date of hire.

PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:

• Bilingual, preferably Spanish and/or Asian Languages (such as Mandarin, Vietnamese, etc.)
• Building contractor, roofing contractor, restoration contractor background
• Residential/Commercial Property estimating software
• This position requires the ability to sit, hear, converse over the telephone, and key frequently on a computer for long periods of time.
• This position may require extended hours, overnight travel, and remote work outside the office as part of our Organization-wide efforts to respond to high claim volume caused by catastrophic storm events.