Claims Examiner

Southern Mutual Church Insurance Company; Columbia (SC); On-site; USD 60,000 - 75,000; Full time

Job summary

Southern Mutual Church Insurance Company seeks a Claims Examiner to evaluate and process insurance claims in compliance with policy terms and applicable law.

The role collaborates with attorneys, adjusters, and policyholders, maintains meticulous files, and mentors junior staff while ensuring timely resolutions.

Qualifications

• 3+ years of Property & Casualty experience.
• Adjuster license required in states handled.
• Desirable professional designations such as AIC/CPCU/AIS.

Responsibilities

• Reviews reports to ensure accuracy in the appraisal process.
• Settles, authorizes or denies payments for routine property/casualty claims.
• Collaborates with attorneys, reinsurers, adjusters, agents and policyholders.
• Keeps claims files organized and private.
• Provides information to accounting for weekly payouts.
• Reviews files for subrogation opportunities and supports recovery.
• Prepares updates for management and excess carriers.
• Communicates claim decisions clearly to insureds and attorneys.
• Establishes reserves based on coverage, liability, and damages analysis.
• Mentors Claims Technicians and supports training.

Skills

P&C experience

Adjuster license

MS Office

Insurance knowledge

Analytical skills

Complex claims handling

Education

Bachelor's degree in Business Administration, Risk Management & Insurance or related field

Tools

ImageRight

Job description

Job Title: Claims Examiner Reports to: Claims Manager

Status: Full Time

Job Summary:

Claims Examiner reviews insurance claims to verify that due process was followed and ensure legal compliance, approve or deny insurance claims and provide customer service to policyholders and claims adjusters as necessary.

Duties/Responsibilities:

• Reviews reports to ensure that no errors have been made in the appraisal process.
• Settles, authorizes or denies payments for routine property/casualty claims based on coverage, appraisal and verifiable damage.
• Works with attorneys, reinsurers, adjusters, agents and policyholders in processing claims.
• Keeps claims files organized and maintained ensuring accuracy and privacy.
• Provides information to accounting to payout claims weekly.
• Reviews each file for subrogation opportunities and develops facts to support the likeliness of successful recovery.
• Prepare appropriate claim updates for management and excess carriers.
• Maintains timely and professional communications with insured.
• Reviews insurance policy and state requirements for coverage determination.
• Establish appropriate reserves based upon competent analysis of coverage, liability and damages and adjust reserves as necessary in a timely manner upon receipt of additional relevant information.
• Effectively communicates claim decisions verbally and in writing to policyholders, claimants, attorneys and agents.
• Notifies Underwriting department of potential underwriting issues.
• Maintains current diary, workplan and activities via Image Right to bring claims to timely resolution.
• Complete necessary claim reporting to management including high exposure alert notifications.
• Maintains current diary, workplan and activities via ImageRight.
• Assists with training and acts as a mentor for new and existing Claims Technicians.

Required Skills/Abilities:

• 3+ years’ experience in Property and Casualty field.
• Adjusters license required in the states in which the position handles, including completing the requisite continuing education.
• Proficient in Microsoft Office Suite.
• Demonstrated knowledge of property insurance contract and the ability to analyze coverage questions.
• Insurance certificates, courses, or professional designations a plus.
• Demonstrated ability to handle complex and/ or litigated claims. Familiarity with state regulations, investigative practices, and coverage analysis.

Education and Experience:

Bachelor’sdegree in Business Administration, Risk Management & Insurance or related field or an equivalent combination of education and property & casualty claims experience. Professional designations desirable, including but not limited to: Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), Associate in Insurance Services (AIS). 3-5 years of P&C claims adjusting or claims examination experience desirable.

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer.

Must be able to lift to 15 pounds at times.

Other duties

Duties, responsibilities and activities may change at any time with or without notice.

EEO statement:

We are committed to providing equal employment opportunities without regard to any statuses protected by federal, state or local law.