Claims Examiner

Swoon; Oakland (CA); On-site; USD 70,000 - 95,000; Full time

Job summary

Swoon seeks a Claims Investigator to evaluate and resolve third-party property damage claims. You will conduct detailed investigations, interview relevant parties, and work with insurers and contractors to facilitate timely settlements.

The role requires strong investigative, analytical, negotiation, and communication skills, with a track record in claims investigations and a valid driver's license. Prior experience in the utility or property damage space is a plus.

Qualifications

• Bachelor's degree or equivalent professional experience.
• Minimum of 2 years of claims investigations experience.
• Valid driver's license with clean driving record.

Responsibilities

• Investigate, evaluate, negotiate, and settle third-party property damage claims.
• Investigate incidents that may result in litigation, including claims involving contractors and insurance carriers.
• Conduct interviews with employees, third parties, and others to gather information and establish facts.
• Review internal records, external documents, reports and evidence to assess liability, damages, and support settlements.
• Analyze claims data to identify trends and opportunities for process improvements.
• Prepare investigation reports and present findings and recommendations to stakeholders.
• Collaborate with management, contractors, carriers, and others throughout the claim process.

Skills

Investigative skills

Negotiation

Analytical thinking

Communication

Organizational skills

Leadership

Written communication

Verbal communication

Problem solving

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Claims software

Excel

Outlook

Job description

The Claims Investigator is responsible for investigating, evaluating, negotiating, and resolving third-party property damage claims. This role conducts detailed investigations into incidents that may result in litigation, evaluates liability and damages, and works with internal business partners, contractors, insurance carriers, and external parties to facilitate fair and timely claim resolutions.

The ideal candidate has experience handling insurance claims investigations, casualty claims adjustment, property damage, and litigation-related matters. Strong investigative, analytical, negotiation, and communication skills are essential.

Key Responsibilities

• Investigate, evaluate, negotiate, and settle third-party property damage claims.
• Investigate incidents that may result in litigation, lawsuits, or other legal proceedings, including reviewing and evaluating claims involving contractors and insurance carriers.
• Conduct interviews with employees, third parties, and other relevant individuals to gather information and establish the facts surrounding claims and incidents.
• Review internal company records, external documents, reports, and other evidence to assess liability, evaluate damages, and support claim negotiations and settlements.
• Analyze claims data to identify trends, recurring issues, and opportunities for process improvements and lessons learned.
• Prepare investigation reports and present findings, recommendations, and claim-related insights to internal business partners and stakeholders.
• Collaborate with management, leadership, contractors, insurance carriers, and other stakeholders throughout the claims investigation and resolution process.

Minimum Qualifications

• Bachelor's degree (BA/BS) or equivalent relevant professional experience.
• Minimum of 2 years of experience handling claims investigations.
• Valid driver's license with a clean driving record.

Desired Qualifications

• Certified Insurance Claims Investigator (CICI) certification.
• 4+ years of experience as a claims investigator, claims adjuster, or in a related field.
• Experience investigating or administering bodily injury, property damage, insurance claims, and litigation matters.
• Previous experience within the utility industry.
• Knowledge of insurance claims processes, particularly casualty claims adjustment.
• Understanding of claims management, investigative procedures, negotiations, and settlement practices.
• Knowledge of tort law, contract law, and relevant legal principles.
• Familiarity with medical terminology and its application to claims investigations.
• Demonstrated ability to communicate and collaborate effectively with multiple levels of management, leadership, employees, and union representatives.
• Strong investigative, analytical, problem-solving, and resolution skills.
• Excellent organizational, leadership, and interpersonal abilities.
• Strong written communication, business documentation, and technical writing skills.
• Excellent verbal communication and presentation skills.
• Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook, as well as experience working with claims management and information systems.