Claims Examiner II

400 AmRisc LLC; Fort Worth (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

CRC Group, a leading property insurer, is seeking an experienced personal lines property claims adjuster to investigate, evaluate, negotiate, and resolve complex claims. The role emphasizes thorough coverage analysis, timely communication with customers, and coordination with SIU and subrogation as needed.

Ideal candidates hold an Associate’s degree, an active adjuster license, and 2+ years of related experience. Spanish fluency is a plus, with normal first-shift hours in a USA-based operation.

Qualifications

• Two years of related, applicable experience.
• Associate’s degree required.
• Adjuster’s License for states in which the company conducts business.

Responsibilities

• Complete coverage investigations and analysis to develop a resolution plan.
• Provide exceptional customer service and handle claims per authority and best practices.
• Investigate policy coverage, cause of loss, and document activity to reach timely resolution.
• Identify and resolve coverage issues through policy review and negotiation with policyholders.
• Plan and conduct investigations (scene work, statements, reports) to identify damages and liable parties.
• Develop damage estimates, verify ownership, and determine repair/replacement methods.

Skills

Investigation

Negotiation

Customer service

Communication

Spanish language

Education

Associate’s degree (A.A. or A.S.)

Job description

Position Summary: The incumbent is responsible for investigating, evaluating, negotiating, and resolving personal lines property claims. They adjust major and complex losses and may also adjust standard losses.

Shift and Language: Regular shift 1st Shift (USA). Language fluency: English (Required).

Responsibilities

• Complete coverage investigations and coverage analysis and develop a detailed resolution plan.
• Provide exceptional customer service and handle claims in accordance with prescribed authority and best claims practices.
• Develop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to reach a quick and accurate resolution.
• Identify, analyze, and resolve coverage issues according to established company protocol, including thorough policy review and analysis of application to the individual claim. With supervisor approval, negotiate with policyholders to settle claims of limited monetary value.
• Develop and direct investigative plans. Conduct timely and detailed investigations that include scene investigation (photos, diagrams, blueprints, maps), statements, official reports (police, fire, weather, hail), and ownership documents (tax liens, judgments, encumbrances). Identify alleged and actual damages, potential liable parties, and possible fraud.
• Conduct thorough damage development, leading to timely and adequate evaluations, including appraisals/estimates, business records, invoices, detailed inventory, purchase records, receipts, credit card statements, and ALE documents. Develop appropriate methods of repair/replacement, verify ownership, and apply any special limitations.
• Establish voice-to-voice communication within 24 hours. Maintain effective communications with the customer at all times and consistently work within specific time limits and authority.
• Maintain company reputation and integrity of insurance products by complying with federal and state regulations, company protocol, and service standards. Maintain current knowledge of regulations and issues, industry activity, and trends.
• Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities. Assist or prepare files for suit, trial, or subrogation.

Required Qualifications

• Two years of related, applicable experience.
• Associate’s degree (A.A. or A.S.) or equivalent from a two‑year college, business school, or technical school.
• Adjuster’s License for states in which the company conducts business.

Preferred Qualifications

• Two to five years of related, applicable experience.
• Fluency in Spanish preferred.

Benefits

• Medical, dental, vision, life, disability, and AD&D insurance.
• Tax‑advantaged savings accounts and 401(k) plan with company match.
• Generous paid time off, company holidays, vacation, sick days, new parent leave, and more.
• Eligibility for restricted stock units and/or a deferred compensation plan.

CRC Group is a diverse workforce and is an Equal Opportunity Employer that does not discriminate based on race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status, or any other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the law. Pay transparency: nondiscrimination provision. E-Verify is required.