Claims Examiner II - Investigate, Resolve Coverage Fast

Wellington Insurance Group; Fort Worth (TX); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

401(k) with company match

Paid time off

Job summary

CRC Group in Fort Worth, TX, is seeking an experienced claims adjuster to handle coverage investigations and resolve claims efficiently. The role involves customer service, detailed policy analysis, and coordinating with SIU and subrogation teams to identify opportunities.

The position requires an AA/AS degree or equivalent and an adjuster license for applicable states. Fluency in Spanish is a plus, and the role offers a comprehensive benefits package and career growth within CRC Group.

Qualifications

• Two years related, applicable experience.
• Associate’s degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school.
• Adjusters License for states in which the Company conducts business.
• Spanish language ability is a plus.

Responsibilities

• Complete coverage investigations and coverage analysis and develop a detailed resolution plan.
• Provide exceptional customer service and handle claims per authority and best practices.
• Develop relationships with customers via telephone and document activity to reach resolution.
• Identify, analyze, and resolve coverage issues per company protocol, including policy review.
• Develop investigative plans with scene investigations, statements, and official reports.
• Conduct thorough damage development and prepare appraisals/estimates and records.
• Maintain voice-to-voice communication within 24 hours and adhere to time limits.
• Uphold company reputation by complying with regulations, protocols, and standards.
• Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities.

Skills

Two years related experience

Spanish (preferred)

Education

Associate’s degree or equivalent

Job description

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

1. Responsible for completing coverage investigations and coverage analysis and develop a detailed resolution plan.

2. Responsible for providing exceptional customer service and handles claims in accordance with prescribed authority and best claims practices.

3. Develop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to come to a resolution quickly and accurately.

4. 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.

5. Develop and direct investigative plans. Conduct timely and detailed investigations that include scene investigation (e.g., photos, diagrams, blueprints, maps), statements, official reports (e.g., police, fire, weather, hail), and ownership documents (e.g., tax liens, judgments, encumbrances). Identify alleged and actual damages, identify potential liable parties, recognize and address potential fraud.

6. 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.

7. Establish voice to voice communication within 24-hours. Maintain effective communications with the Customer at all times. Consistently work within specific time limits and authority.

8. 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.

9. Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities. Assist or prepare files for suit, trial, or subrogation.

Required Qualifications:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Two years related, applicable experience.

2. Associate’s degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school.

3. Adjusters License for states in which the Company conducts business.

Preferred Qualifications:

1. Two to five years related, applicable experience.

2. Fluency in Spanish preferred.

General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being – physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan.

CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace.

EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify