Claims Examiner II (Remote)

California FAIR Plan Association; Oregon; Hybrid; USD 70,000 - 90,000; Full time

Job summary

California FAIR Plan Association is seeking a Claims Examiner II to manage property claims from intake through settlement. You will interact with policyholders and independent adjusters, review records for coverage, and advise on settlements in line with regulations and company practices.

The role requires a bachelor’s degree, strong communication skills, and 2+ years of property claims experience, including HO claims up to $300,000.

Qualifications

• Bachelor's degree or equivalent preferred.
• Excellent oral and written communication skills.
• MS-Office (Word/Excel) experience required.
• 2+ years property claims experience and strong customer service.
• CEA certification and Fair Claims Settlement Practices knowledge.
• 3 years total claims experience; 2 years HO claims up to $300,000.
• 1 year carrier experience required.

Responsibilities

• Investigate, evaluate, and resolve claims for fair settlements.
• Adjust reserves and provide reserve recommendations per policy.
• Enter claim transactions clearly and accurately.
• Review claims with independent adjusters and verify coverage.
• Conduct daily diary reviews and issue timely status letters.
• Pay and process claims within designated authority.
• Supervise independent adjusters per CFP IA guidelines.
• Ensure compliance with insurance regulations and policy.
• Prepare accurate correspondence to policyholders.
• Negotiate settlements reflecting actual losses while protecting insurer.
• Consult with management and legal on litigated claims.

Skills

Communication skills

MS Office proficiency

Education

Bachelor's degree

CEA cert

Fair Claims Practices cert

Tools

MS Office

Job description

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