Claims Examiner II (Remote)

California FAIR Plan Association; Los Angeles (CA); A distancia; USD 80.000 - 110.000; Jornada completa

Descripción de la vacante

California FAIR Plan Association seeks a Claims Examiner II role to process and settle insured property claims in compliance with regulations. You will interact with independent adjusters and policyholders to determine coverage and payments, while maintaining adherence to company practices and Fair Claims Settlement regulations.

The position focuses on claims ranging in complexity, with responsibilities including reserving, investigations, and timely settlements, ensuring accurate documentation

Formación

• Bachelor's degree or equivalent preferred.
• Excellent oral and written communication.
• MS-Office proficiency required.
• 2+ years property claims experience and excellent customer service.
• Certified in CEA.
• 3 years total claims experience, 2 years handling HO claims up to $300,000.
• 1 year Carrier Experience Required.

Responsabilidades

• Investigate, evaluate, and resolve claims to promote fair settlements.
• Adjust reserves and provide reserve recommendations.
• Enter claim transactions clearly and concisely.
• Examine claims by independent adjusters and verify coverage.
• Perform daily diary reviews to ensure status letters are sent per regulations.
• Pay and process claims within designated authority level.
• Supervise independent adjusters to adhere to guidelines.
• Maintain compliance with insurance regulations and company policies.
• Create accurate correspondence for policyholders and secure missing information.
• Negotiate settlements reflecting actual insured losses while protecting insurer.
• Consult with Claims Management and legal counsel on litigation-related claims.

Conocimientos

Communication skills

Customer service

MS Office proficiency

Educación

Bachelor's degree or equivalent

CEA certification

Herramientas

MS Office

Descripción del empleo

POSITION SUMMARY

Process insurance claims for property losses based on coverage, appraisal, and verifiable damage. Interact with independent adjusters and policy holders, review claim forms and other records to determine insurance coverage. Make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Investigate, evaluate, and resolve claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
• Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies.
• Enter claim transactions, in a clear and concise manner.
• Examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders.
• Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations.
• Pay and process claims within designated authority level.
• Supervise independent adjusters to ensure adherence to CFP IA Guidelines.
• Maintain compliance with the Department of Insurance and Company policy and procedures.
• Create correspondence to policyholders that is accurate and complete. Communicate with insureds and/or others involved to secure missing information.
• Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims.
• Confer with Claims Management and legal counsel on claims involving litigation.

ADDITIONAL DUTIES AND RESPONSIBILITIES

This role may include handling the entire claim (except inspection), or may be responsible for a specific coverage, such as Personal Property or Fair Rental Value. This role will focus on claims ranging from $100,000 to $300,000 in damages, but the Claims Examiner II may receive larger or smaller claims when necessary.

EDUCATION AND EXPERIENCE

• Minimum bachelor's degree or equivalent preferred.
• Excellent oral and written communication skills.
• Working experience with MS-Office (especially Word and Excel) is required.
• 2 + years property claims experience and excellent customer service.
• Certified in CEA and Fair Claims Settlement Practices.
• 3 years total claims experience, 2 years handling HO claims up to $300,000
• 1 year Carrier Experience Required