POSITION SUMMARY

The Claims Examiner III processes insurance claims for property 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. This person will make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.

PRINCIPAL DUTIES & RESPONSIBILITIES

• Investigate, evaluate, and resolve 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, in a clear and concise manner.
• Examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders.
• Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations.
• Pay and process claims within designated authority level.
• Supervise independent adjusters to ensure adherence to CFP IA Guidelines.
• Maintain compliance with the Department of Insurance and Company policy and procedures.
• Create correspondence to policyholders that is accurate and complete. Communicate with insureds and/or others involved to secure missing information.
• Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims.
• Confer with Claims Management and legal counsel on claims involving litigation.

ADDITIONAL DUTIES & RESPONSIBILITIES

Claims Examiner III: This role may include handling the entire claim (except inspection), or may be responsible for a specific coverage, such as Personal Property or Fair Rental Value. This role will focus on claims over $300,000 in damages, but the Claims Examiner III may receive smaller claims when necessary.

EDUCATION & 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.
• 2 + years property claims experience and excellent customer service.
• Certified in CEA and Fair Claims Settlement Practices.

ADDITIONAL REQUIREMENTS (PRIOR EXPERIENCE)

Claims Examiner III: 5 years total claims experience, 2 years handling HO claims over $300,000.

2 Years Carrier experience required.

Apply To this Job

Company : California FAIR Plan Association

Salary : Work from home