Job Details

Claims Examiner III

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 and responsibilities include investigating, evaluating, and resolving claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. They adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies. They enter claim transactions in a clear and concise manner. They examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders. They conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations. They pay and process claims within designated authority level. They supervise independent adjusters to ensure adherence to CFP IA Guidelines. They maintain compliance with the Department of Insurance and company policy and procedures. They create correspondence to policyholders that is accurate and complete. They communicate with insureds and/or others involved to secure missing information. They promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims. They confer with Claims Management and legal counsel on claims involving litigation.

Additional duties and responsibilities for Claims Examiner III 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 and experience requirements include a minimum bachelor's degree or equivalent preferred, excellent oral and written communication skills, working experience with MS-Office (especially Word and Excel), 2+ years property claims experience and excellent customer service, and certification in CEA and Fair Claims Settlement Practices.

Additional requirements for prior experience include 5 years total claims experience, 2 years handling HO claims over $300,000, and 2 years carrier experience required.