The Claims Coverage Specialist reviews and evaluates moderate to complex coverage issues (homeowners and commercial claims) and makes recommendations for resolution. Researches and documents legal interpretations and case law regarding policy interpretation. Interacts with staff, independent adjusters, and policyholders to oversee settlements that have been made in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations. Assists in resolving and tracking Department of Insurance compliance regulations.
PRINCIPAL DUTIES & RESPONSIBILITIES
- Examine claims with moderate to complex coverage issues to determine the extent of coverage and validity of the claims.
- Interact with customers, staff, independent adjusters, and management to resolve coverage issues.
- Research and document legal interpretations and case law in relation to claims coverages.
- Confer with claims management and legal counsel on claims involving litigation.
- Maintain compliance with the Department of Insurance and Company procedures.
- Assist in resolving Department of Insurance complaints, as well as analyze any violations and recommend trends or areas of opportunity for training/process updates.
- Understanding of fraudulent and illegal insurance practices.
EDUCATION & EXPERIENCE
- Bachelor’s degree or equivalent.
- Minimum of 5 to 7 years property claims adjusting experience and excellent customer service.
- Underwriting and/or legal experience can be combined with property claims experience.
- Experience handling moderate to complex coverage issues in homeowners and commercial claims.
- Experience monitoring company compliance regulations.
- Experience responding to and communicating with the Department of Insurance.
- Excellent oral and written communication skills.
- Working experience with MS-Office (especially Word and Excel).
- Comprehensive understanding of policy contract/statutes and claims processes.
- Certified in California Earthquake Authority and CA Fair Claims Settlement Practices preferred.