Claims Examiner III

Job Description The incumbent is responsible for investigating, evaluating, negotiating, and resolving personal lines property claims. Responsible for adjusting major and complex losses in their entirety, including high dollar claims. May also adjust standard losses. Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Responsible for completing coverage investigations and coverage analysis and develop a detailed resolution plan. 2. Responsible for providing exceptional customer service and handles claims in accordance with prescribed authority and best claims practices. 3. Develop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to come to a resolution quickly and accurately. 4. Identify, analyze, and resolve coverage issues according to established Company protocol, including thorough policy review and analysis of application to the individual claim. With supervisor approval, negotiate with policyholders to settle claims of limited monetary value. 5. Develop and direct investigative plans. Conduct timely and detailed investigations that include scene investigation (e.g., photos, diagrams, blueprints, maps), statements, official reports (e.g., police, fire, weather, hail), and ownership documents (e.g., tax liens, judgments, encumbrances). Identify alleged and actual damages, identify potential liable parties, recognize and address potential fraud. 6. Conduct thorough damage development, leading to timely and adequate evaluations, including appraisals/estimates, business records, invoices, detailed inventory, purchase records, receipts, credit card statements, and ALE documents. Develop appropriate methods of repair/replacement, verify ownership, and apply any special limitations. 7. Establish voice to voice communication within 24-hours. Maintain effective communications with the Customer at all times. Consistently work within specific time limits and authority. 8. Maintain company reputation and integrity of insurance products by complying with federal and state regulations, Company protocol, and service standards. Maintain current knowledge of regulations and issues, industry activity, and trends. 9. Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities. Assist or prepare files for suit, trial, or subrogation. 10. Train and mentor lower level Examiners, as appropriate. May conduct Quality Audits. 11. Handle authority requests during the absence of a Supervisor. Required Qualifications The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Five years related, applicable experience. Associate’s degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school. Adjusters License for states in which the Company conducts business. Preferred Qualifications Five to eight years related, applicable experience. Fluency in Spanish preferred. Completion of a major insurance designation, or actively pursuing insurance related courses. #J-18808-Ljbffr