Senior Commercial Claims Examiner

📋 Description

• Verify loss facts and relevant information to assess and confirm coverage.

• Set ultimate reserves (estimated costs to close the file based on known details) as soon as feasible and adjust them following any event that alters exposure.

• Provide clear explanations and appropriate responses to insured individuals, public adjusters, attorneys, and contractors during phone interactions; additionally, contact relevant parties to gather necessary information, deliver timely updates on investigation status, and clarify settlements and/or final claim outcomes.

• Promptly submit requests for reserve and payment approvals as needed.

• Recognize claims that require a Reservation of Rights and refer them for management approval.

• Develop and implement an appropriate ADR strategy in accordance with statutory guidelines.

• Check emails and messages daily.

• Respond to all calls, emails, and inquiries on a daily basis.

• Utilize advanced negotiation skills to achieve resolution of disputed claims with insured parties or their legal representatives.

• Oversee the appraisal process, ensuring effective communication to maintain timely progress.

• Draft denial letters for management's approval.

• Identify and refer claims with subrogation potential to the subrogation department.

• Detect and refer cases that exhibit potential NICB fraud indicators.

• Conduct virtual investigations and resolve claims as necessary using video technology.

• Close all files promptly and thoroughly as appropriate.

• Act as a mentor and/or trainer to junior adjusters as required.

• Rigorously adhere to Best Practices and operational guidelines, along with all statutory requirements.

• Interface with company clients, carriers, adjusters, or covered parties.

• Communicate with agents regarding the status of claims.

• Complete and/or review, approve, or escalate reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as relevant.

• Resolve disputes related to claims resolution.

• Be responsible for reopening and re-evaluating claims as necessary.

• Participate in litigation when applicable.

⛳️ Requirements

• Bachelor's degree.

• A minimum of 10 years of experience in Commercial claims is preferred.

• Comprehensive professional knowledge of all facets of claims operations.

• Florida 520/620 license is mandatory.

• Capability to obtain AL, GA, NC, and SC adjusters licenses.

• Strong background in commercial coverage interpretation and claims handling is essential.

• Must possess commercial construction knowledge and be proficient in Xactimate.

🏝️ Benefits

• Remote work schedule!

• Health & Wellness: Company-sponsored Medical, Dental, Vision, Life, and Disability Insurance (Short-Term and Long-Term).

• Financial Security: 401k Retirement Plan with a generous 9% match.

• Work-Life Balance: Four weeks of PTO and Pet Insurance for your furry family members.