POSITION 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 policy holders, review claim forms and other records to determine insurance coverage, payment recommendations and settlements have been made in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies.
Enter claim transactions, such as payments, reserves, notes, and other documentation in a clear and concise manner.
Examine claims investigated by independent adjusters, including further investigation of questionable claims to determine payment authorization.
Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders timely and in accordance with Department of Insurance regulations.
Pay and process claims within designated authority level.
Supervise independent adjusters to ensure they have followed CFP IA Guidelines.
Comprehensive understanding of policy contract/statutes and claims processes of the CFP.
Understanding of fraudulent and illegal practices.
Maintains compliance with the Department of Insurance and Company policy & procedures.
Reviews reports submitted by independent adjusters, verifies coverage, and authorizes timely payments to policyholders.
Reviews independent adjuster’s correspondences to policyholders for accuracy and completeness. 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.
Confer with Vice President of Claims and legal counsel on claims involving litigation.
EDUCATION AND EXPERIENCE
Minimum Bachelor’s degree or equivalent preferred.
Excellent oral and written communication skills.
Working experience with MS-Office (especially Word and Excel) is required.
3 to 5 years property claims experience and excellent customer service.
Comprehensive understanding of policy contract/statutes and claims processes.
Certified in CEA and Fair Claims Settlement Practices preferred.
