Sr. Claims Examiner (Remote)

· Los Angeles, California
Employment Type Full-Time

Position Summary:

Reviews, evaluates and processes insurance claims and makes recommendations for resolution.  Examines, and authorizes insurance claims investigated by independent adjusters.  Interacts with independent adjusters and policyholders to oversee the review of claim forms and other records to determine insurance coverage and that payment recommendations and settlements have been made in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.

 

Principal Duties & Responsibilities:

  • Examine moderate to complex claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims.
  • Review and adjust moderate to high reserves submitted by independent adjusters to ensure reserving activities are consistent with company policies.
  • Reviews reports submitted by independent adjusters, verifies coverage, and authorizes timely payments to policyholders
  • Maintain contact with independent adjusters, policy holders, vendors, or brokers when necessary.
  • Promptly negotiates settlements, making sure that the settlement reflects the actual insured losses while ascertaining that the insurer is protected from invalid claims.
  • Confer with Claims Management and legal counsel on claims involving litigation.
  • Enter claim transactions, such as payments, reserves, notes, and other documentation in a clear and concise manner.
  • Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
  • Conduct daily diary reviews on claim files to insure status letters are sent to policyholders timely and in accordance with Department of Insurance regulations.
  • Pay and process claims within designated authority level.
  • Supervise independent adjusters to ensure they have followed CFP IA Guidelines.
  • Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures.
  • Maintain compliance with the Department of Insurance and Company procedures.
  • Understanding of fraudulent and illegal practices.
  • Reviews independent adjuster’s correspondences to policyholders for accuracy and completeness. Communicates to adjusters and/or others involved to secure missing information.

 

The individual in this position must meet the following general requirements:

  • Bachelor’s degree or equivalent.
  • 5 to 7 years of property claims adjusting experience and excellent customer service.
  • 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 CEA and Fair Claims Settlement Practices preferred.

Thank You

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  • Location
    Los Angeles, California
  • Employment Type
    Full-Time