Claims Examiner II

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

📋 Description

• Evaluate insurance policies and documents to ascertain coverage.

• Investigate and assess claim data to establish liability.

• Manage intricate 1st Party Property Claims.

• Support legal proceedings, mediations, and arbitrations.

• Collaborate with Counsel in the defense of litigation.

• Establish timely and adequate reserves in line with the company's reserving philosophy.

• Engage specialists to assess claims.

• Oversee vendor performance and manage expenses.

• Assess, negotiate, and determine settlement values.

• Maintain communication with relevant parties throughout the claim process.

• Discuss coverage determinations, additional information requirements, and settlement figures.

• Manage claims in accordance with Best Practices.

• Track and complete assigned claims inventory.

• Deliver Best-In-Class customer service to insured clients and agents.

• Update and maintain claims files.

• Identify subrogation prospects and safeguard recovery interests.

• Recognize fraud indicators and refer cases to 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.

• Must possess a Property & Casualty Insurance License.

• Obtain and maintain a state adjuster’s license.

• Fulfill state continuing education requirements.

• Technical expertise in insurance claims handling.

• Ability to cultivate relationships and communicate effectively with a diverse range of clients, carriers, and colleagues.

• Strategic vision coupled with tactical execution to meet goals and objectives.

🏝️ Benefits

• Commitment to delivering Best-In-Class customer service.

• Opportunity for remote work arrangement.