Claims Specialist

Claims Investigator

This position is responsible for investigating claims, determining liability, confirming coverage, assessing damages, and negotiating settlements. It involves managing claims from initiation to resolution, ensuring thorough documentation, and communicating effectively with all parties involved.

Essential Functions

Required Responsibilities*

• Investigates both member and third-party claims, reviewing coverage, setting reserves, determining liability, assessing damages, and initiating claim processes to ensure proper handling and settlement.
• Maintains accurate records of all claims and related activities, ensuring that the claim management system is regularly updated and all documentation is complete.
• Reviews documentation on damaged property, bodily injuries, employment and law enforcement matters, liability, immunity, etc., and determines claims-related damages, prepares releases, and processes payments.
• Communicates regularly with internal staff, Members, claimants, witnesses, repair facilities, contractors, vendors, police, fire departments, special investigators, attorneys, and other parties essential to the claims process.
• Reviews reports from independent adjusters, appraisers, and claimants, ensuring all necessary documentation is provided and properly supported.
• Reviews and handles litigation files, reviews settlement proposals, submits authority requests (as applicable), and prepares settlement documents.
• Identifies and reports on subrogation, salvage, and potential fraud in claims.
• Attends mediations and trials as needed for litigation matters.

Job Requirements

Education, Work Experience, Certifications** Required

• B.A. or B.S. degree in Business, Insurance, Risk Management, or related field
• Years of Experience: 3
• Area of Experience: Claims Processing, Insurance, or related areas
• Active Adjuster License – Texas – Property and Casualty

Equivalent combinations of education and experience will be accepted Preferred

• None

Essential Competencies and Skills** Required

• Experience in the Property and Casualty Insurance Industry
• Valid Texas driver's license and a good driving record
• Possess knowledge and understanding of relevant laws, rules, and regulations
• Knowledge of insurance principles and the ability to interpret insurance contracts and endorsements to determine coverage eligibility and liability
• Decision-making, problem-solving, negotiation, and conflict resolutions skills
• Proficiency in MS Word
• Proficiency in MS Excel
• Proficiency in MS Outlook

Preferred

• None

** To perform this job successfully, an individual must be able to perform each primary responsibility satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities.

Supplemental Information

Work Leadership Requirements

• This position is not a people manager.
• This position does not have indirect reports.

Travel Requirements

• Occasional overnight travel (by car or air)

Physical Requirements

• Be able to withstand typical office work that includes periods of sitting, standing, typing, etc. indoors.
• In addition to typical office work, must be able to exert up to 10 pounds of force occasionally to move objects.
• Requires close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer screen, visual inspection, assembly of parts, or extensive reading.
• Ability to have a flexible work schedule to meet business needs and be at work on-site during specified or core hours.
• Ability to safely operate a motor vehicle for extended periods, including prolonged sitting, use of hands and feet to operate vehicle controls, and maintaining visual awareness in varying traffic and weather conditions.
• Must be able to operate standard computer hardware.

Benefits

At the Texas Municipal League Intergovernmental Risk Pool, we value our team and offer a robust benefits package designed to support your health, well-being, and future:

• Medical Insurance – 100% employer-paid for employees, with subsidized coverage available for dependents
• Dental & Vision Insurance – 100% employer-paid comprehensive coverage for you and your family
• Flexible Spending Accounts (FSA) – for healthcare and dependent care expenses
• Health Savings Account (HSA) – additional support for medical expenses
• Texas Municipal Retirement System (TMRS) – with a generous 2:1 employer match
• 457(b) Deferred Compensation Plan – 6.2% employer contribution to support long-term financial planning
• Disability Insurance – 100% employer-paid short-term and long-term disability coverage
• Life and AD&D Insurance – 100% employer-paid coverage that provides added financial protection
• Paid Time Off – includes 9 holidays, vacation, sick leave, and personal holidays
• Education Assistance – up to $6,000 annually to support your continued learning and professional development