Claims Examiner III

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

Job summary

Wellington Insurance Group in the United States (Fort Worth, TX) seeks an experienced Claims Adjuster to investigate, evaluate, negotiate, and resolve personal lines property claims, including major losses. The role emphasizes coverage analysis, detailed investigations, and timely resolutions in a strict regulatory framework.

Responsibilities include developing resolution plans, providing exceptional customer service, and coordinating with SIU/subrogation.

Qualifications

• Five years related, applicable experience.
• Associate’s degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school.

Responsibilities

• Complete coverage investigations and develop a detailed resolution plan.
• Provide exceptional customer service and handle claims per authority and best practices.
• Develop relationships with customers; investigate policy coverage and determine cause of loss to resolve claims quickly.
• Identify and resolve coverage issues per company protocol with supervisor approval for monetary settlements.
• Develop investigative plans; conduct scene investigations, collect statements, and obtain official reports.
• Perform damage development including appraisals, records, invoices, and ownership documents; determine methods of repair.
• Maintain voice contact within 24 hours; communicate effectively with customers within time limits.
• Maintain regulatory knowledge and comply with company protocols and service standards.
• Coordinate with SIU and Subrogation; assist for suit or subrogation when needed.
• Train or mentor junior staff; conduct quality audits as appropriate.
• Handle authority requests during supervisor absence.

Skills

Claims adjustment

Investigation

Policy analysis

Negotiation

Education

Associate's degree or equivalent

Tools

Adjuster license

Job description

Job Description

The incumbent is responsible for investigating, evaluating, negotiating, and resolving personal lines property claims. Responsible for adjusting major and complex losses in their entirety, including high dollar claims. May also adjust standard losses.

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.

10. Train and mentor lower level Examiners, as appropriate. May conduct Quality Audits.

11. Handle authority requests during the absence of a Supervisor.

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.

• Five 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.

Preferred Qualifications

• Five to eight years related, applicable experience.
• Fluency in Spanish preferred.
• Completion of a major insurance designation, or actively pursuing insurance related courses.