Senior Claims Examiner

Senior Claims Examiner

Join a team where your expertise truly makes a difference. As a Senior Claims Examiner, you'll lead the investigation and resolution of complex commercial property claims, guiding customers through critical moments with confidence and professionalism. This role combines technical challenge, independent decision-making, and meaningful customer interaction, giving you the opportunity to leverage your claims expertise while influencing fair and timely claim resolutions. If you thrive in a fast-paced environment, enjoy solving complex problems, and value delivering outstanding customer service, this is an opportunity to take your claims career to the next level.

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

Physical Requirements:

• 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.

Why work with TWIA?

The Association offers a comprehensive and competitive benefits package designed to support both your professional success and personal well-being. A key highlight of our offering is a fully remote work environment, allowing you to contribute from home with no relocation required.

In addition to our benefits, Texas Windstorm Insurance Association fosters a collaborative and mission-driven work environment where employees are valued, supported, and encouraged to grow. Our teams work closely across departments, promoting transparency, innovation, and a shared commitment to serving our policyholders and communities.

Employees also enjoy:

• Comprehensive medical, dental, vision, group life, AD&D, and dependent life insurance coverage
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) with a generous annual HSA employer contribution
• A 401(k) retirement plan with employer matching contributions up to 6%, in addition to a pension plan that begins vesting at 5 years of employment
• Active support for professional growth, including ongoing training and professional development opportunities sponsored by TWIA, support to obtain professional certifications, and a tuition reimbursement program
• Generous paid time off, including vacation, sick leave, paid holidays, and personal days
• Flexible scheduling to support work-life balance