CLAIMS EXAMINER

Claims Examiner

Salary Range $25.00 - $35.00 Hourly Education Level 4 Year Degree Category Insurance

Description

As an experienced claims professional, you will play a critical role by being part of our claims team that focus on delivering an empathetic voice and provide exceptional customer service by achieving a prompt, fair and equitable settlement according to fair claims handling requirements. In this role, you will investigate, evaluate and negotiate claims of varying complexity. This includes knowledge of contracts, investigation, and determination of coverage, liability, damages, and the setting of proper reserves. This may also include the ability to investigate, evaluate and negotiate bodily injury claims with both attorney represented claimants as well as claimants without attorney representation.

Duties and Responsibilities:

• Empathize and assist those that have been involved in an auto accident.
• Evaluate losses utilizing critical thinking and solid judgment to solve problems, make decisions, and resolve complex issues.
• Conduct prompt, thorough and fair investigations by obtaining relevant facts to determine coverage, origin and extent of loss.
• Monitor costs to ensure they are reasonable and customary.
• Keep the insured and others informed about the claim status with timely and accurate written/verbal communications to resolve claims efficiently and effectively.
• Confirm or deny coverage of the claim based on the facts and the policy terms and conditions.
• Negotiate the settlement of claims, based on experience, under varying levels of oversight from supervisor and management according to authority levels and file complexity. Maintain a diary system for file review and document files to reflect status of work being performed on the file.
• Document and communicate all claims activities timely and effectively and in a manner which supports the outcome of the claims file.
• Answer phone calls and respond to emails and voicemails in a timely manner.
• Other duties as assigned.

This is an on-site position. However, a hybrid schedule may be offered after a probationary period of 6 to 12 months, depending on experience and performance.

Qualifications

To be successful, an individual must have a disciplined approach to all job-related activities. A solid foundation of personal organization, sound decision making, analytical skills, customer service skills, and a clear understanding of team commitment are required. This individual should demonstrate the ability to communicate in a clear manner, possess excellent interpersonal skills and must also demonstrate confidence in their decision-making ability.

• Exercise sound financial judgment and discretion in handling insurance claims.
• Knowledge of automobile claims: coverage evaluation, claims investigation, loss assessment, evaluation, reserves, insurance regulations, negotiation, and settlement.
• Knowledge of investigation management, including but not limited to taking and using recorded statements, determining coverage and application of coverage to claims, negotiation, and resolution of claims.
• Knowledge of California-specific adjusting, including California insurance claims regulatory compliance, relevant case law, and California claims legal framework.
• Arizona, Texas, Washington, and Oregon claim knowledge as a plus.
• Self-directed individual who works well with minimal supervision.
• Must have strong analytical skills necessary to make decisions, resolve issues inherent in handling claims effectively by dealing with situations at various levels of intensity and reach a resolution.
• Must be able to interpret insurance policies and various contracts, perform analytical research, and make sound decisions using good judgment.
• Ability to effectively operate a computer and have working knowledge of MS Office applications.
• Ability to multitask.
• Ability to adapt quickly in a fast-paced environment and strong attention to detail.
• An effective listener with the ability to manage, analyze, and execute directions.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of co-workers, supervisors, managers, internal customers, external customers, vendors, and other insurance professionals.
• A Texas All Claims Insurance License may be required, depending on company forecasts.

Education or Experience

Preferred: 2 or more years of experience in automobile claims handling.

Preferred: College degree.

Required: Able to meet minimum efficiency standards for customary business applications such as Word, Excel, Google Sheets, and Teams.