Sr. Claims Examiner

Job Description

Job Description

Job Summary
The Senior Claims Examiner is a remote position responsible for handling daily residential and commercial property insurance claims, catastrophe (CAT) claims, and complex claims across our operating territories in Florida, Louisiana, and Texas. This role requires a seasoned claims professional with a thorough understanding of policy coverages, strong investigative skills, and the ability to manage claims from first notice of loss through resolution while adhering to state-specific compliance requirements and company claims handling guidelines.

Duties and Responsibilities

• Handle daily residential and commercial property claims, CAT claims, and complex claims across Florida, Louisiana, and Texas in accordance with state regulatory requirements and company guidelines.
• Investigate claims thoroughly to confirm cause of loss, determine coverage based on applicable policy terms and conditions, and identify when a field adjuster, independent adjuster, or other expert is needed.
• Review and analyze repair estimates to determine what is covered, reasonable, and consistent with the scope of loss; negotiate settlements accordingly within authority level.
• Prepare and issue coverage determination letters, reservation of rights letters, denial letters, follow-up correspondence, and response letters in a professional and timely manner.
• Conduct thorough recorded statements from insureds, claimants, and witnesses as appropriate during the claims investigation process.
• Maintain proper reserves throughout the lifecycle of each claim, adjusting as new information is obtained.
• Collaborate with field adjusters, independent adjusters, and contractors; provide clear directions and establish productive working relationships.
• Handle claims involving attorney representation and public adjusters professionally, including responding to demands and ability to negotiate favorable resolutions.
• Communicate coverage decisions clearly and effectively to all parties, both verbally and in writing.
• Investigate and pursue subrogation opportunities; understand and manage liability-related claims.
• Maintain accurate, thorough, and timely claim file documentation within the claims management system (CMS).
• Work with defense counsel on litigated files and manage associated legal expenses.
• Deliver exceptional customer service through professional and timely communication via phone, email, and written correspondence.
• Other tasks and projects as may be assigned consistent with the responsibilities of this role.

Qualifications

• Minimum of 5 years of experience handling residential and commercial property and casualty insurance claims, including daily claims, CAT claims, and complex claims, with demonstrated proficiency in the duties outlined above.
• Florida All Lines Adjuster (620) License required; multi-state licensure preferred.
• Associate’s degree minimum; Bachelor’s degree preferred; or an equivalent combination of education and directly related claims experience.
• Strong knowledge of residential and commercial property insurance policy language, coverages, and endorsements, coverages, and exclusions.
• Proven ability to review and analyze repair estimates and understand what is covered, reasonable, and appropriate.
• Excellent letter writing skills with experience preparing coverage letters, denial letters, reservation of rights letters, and response correspondence.
• Ability to conduct professional and thorough recorded statements.
• Experience handling claims involving attorneys, public adjusters, and represented parties.
• Strong investigative skills with the ability to confirm cause of loss and identify when specialized expertise is required.
• Exceptional organizational skills with the ability to manage multiple claims simultaneously and meet deadlines.
• Excellent verbal and written communication skills with the ability to interact professionally with internal and external stakeholders.
• Knowledge of state-specific compliance requirements for Florida, Louisiana, and Texas.
• Knowledge and experience with Xactware/Xactimate products strongly preferred.
• Operational proficiency with MS Office products required.
• Bilingual preferred; written and verbal proficiency in a second language is a plus.

Safepoint MGA, LLC does not offer immigration sponsorship or support for this role. This includes serving as the immigration employer of record or providing documentation or assistance for work authorization processes now or in the future, including H-1B, OPT, STEM OPT, CPT, J-1, etc.

Essential Functions

• Verify, investigate, and evaluate coverage, liability, and damages on assigned claims; determine appropriate reserves and settlement values in compliance with state regulatory guidelines.
• Manage the claims system to accurately maintain files, diaries, and documentation throughout the claims process.
• Effectively communicate coverage decisions and claims status updates to all parties in a clear, professional, and timely manner.
• Identify subrogation potential early in the claims process and take appropriate action to preserve and pursue recovery.

Working Conditions
This is a fully remote position. The employee is expected to maintain a professional and productive home office environment with reliable internet access. Standard office equipment including computer, phone, and applicable software programs will be utilized on a regular basis.

Physical Requirements
While performing the duties of this job, the employee is regularly required to communicate verbally and in writing. The employee is frequently required to remain at a workstation for extended periods, operate a computer, and use standard office equipment.

 

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