Claims Examiner II

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.

Required Qualifications: 1. Two years related, applicable experience. 2. Associate’s degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school. 3. Adjusters License for states in which the Company conducts business. Preferred Qualifications: 1. Two to five years related, applicable experience. 2. Fluency in Spanish preferred. General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being – physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full‑time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax‑advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify #J-18808-Ljbffr Wellington Insurance Group