Claims Examiner II

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

📋 Description

• Examine insurance policies and documents to assess coverage.

• Investigate and evaluate claim information to ascertain liability.

• Manage high-complexity First Party Property Claims.

• Support legal actions, mediations, and arbitrations, collaborating with Counsel in litigation defense.

• Establish timely and appropriate reserves in accordance with the company’s reserving philosophy.

• Engage experts for claim evaluations.

• Oversee vendor performance and manage expenses.

• Assess, negotiate, and establish settlement values.

• Communicate with involved parties regarding coverage determinations, additional information, and settlements.

• Process claims following Best Practices.

• Track and complete assigned claims inventory.

• Deliver exceptional customer service to insured individuals and agents.

• Update and maintain comprehensive claim files.

• Identify subrogation opportunities and safeguard recovery interests.

• Recognize fraud indicators and refer files to the Special Investigations Unit (SIU).

• Participate in both internal and external claims audits.

• Provide oversight for Third-Party Administrators (TPAs).

⛳️ Requirements

• High School diploma or GED.

• 5–9 years of experience in claims management.

• Possession of a Property & Casualty Insurance License is required.

• Must acquire and maintain a state adjuster’s license and fulfill state continuing education obligations.

• Technical expertise in handling insurance claims.

• Ability to build relationships and communicate effectively with a diverse clientele, carriers, and colleagues.

• Experience in managing complex First Party Property Claims.

🏝️ Benefits

• Not specified