Claims Examiner II

This is a fully remote position, open to applicants in California.

📋 Description

• Process insurance claims related to property losses, assessing coverage, appraisals, and verifiable damage.

• Collaborate with independent adjusters and policyholders effectively.

• Analyze claim forms and relevant records to ascertain insurance coverage.

• Provide payment recommendations and settlements in line with company policies, procedures, and Fair Claims Settlement Practices regulations.

• Investigate, assess, and resolve various claims.

• Adjust reserves and offer reserve recommendations as necessary.

• Accurately enter claim transactions in a clear and concise manner.

• Review claims evaluated by independent adjusters, including additional investigations of questionable claims and verification of coverage.

• Conduct daily diary reviews on claim files and ensure that status letters are dispatched in accordance with Department of Insurance regulations.

• Process and pay claims within the designated authority level.

• Oversee independent adjusters to ensure compliance with CFP IA Guidelines.

• Uphold adherence to Department of Insurance and company policies and procedures.

• Generate precise and complete correspondence to policyholders while securing missing information.

• Negotiate settlements that reflect actual insured losses while safeguarding the insurer from invalid claims.

• Consult with Claims Management and legal counsel on claims that involve litigation.

• Manage the entire claim process excluding inspection, or specific coverages such as Personal Property or Fair Rental Value.

• Handle claims typically ranging from $100,000 to $300,000 in damages, with the flexibility to manage larger or smaller claims as needed.

⛳️ Requirements

• A minimum of a bachelor’s degree or equivalent is preferred.

• Exceptional oral and written communication skills are essential.

• Proficient experience with MS Office (particularly Word and Excel) is required.

• At least 2 years of property claims experience along with outstanding customer service skills.

• Certification in CEA and Fair Claims Settlement Practices is necessary.

• A total of 3 years of claims experience, including 2 years managing HO claims up to $300,000.

• 1 year of required Carrier Experience.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health insurance and retirement plans.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on employee well-being.