Reviews, evaluates and processes complex 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 AND RESPONSIBILITIES
- Manages a caseload of high complexity property claims from assignment through resolution.
- Examines large loss claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims.
- Reviews and adjusts large loss 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
- Reviews independent adjuster’s correspondences to policyholders for accuracy and completeness. Communicates to adjusters and/or others involved to secure missing information.
- Leads a team of independent adjusters as assigned during Catastrophe and /or high claims volume time periods.
- Collaborates with assigned internal personnel and/or legal counsel on claims involving litigation.
- Investigates, evaluates, and adjusts claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
- Oversee independent adjuster files to ensure they have followed CFP IA Guidelines.
- Verifies and analyzes 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.
- Identify fraud or illegal activity indicators and follow internal processes to refer the questionable claim to the appropriate personnel for follow up.
- Promptly negotiates settlements, making sure that the settlement reflects the actual insured losses while ascertaining that the insurer is protected from invalid claims.
EDUCATION AND EXPERIENCE
- Bachelor’s degree or equivalent.
- 5+ years of property claims adjusting experience, including 2+ years adjusting large loss property claims.
- 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.