Commercial Claims Examiner

Jobgether; Oregon; Hybrid; USD 64,000 - 71,000; Full time

Benefits offered by this job

Remote work

Job summary

Partner Company seeks an experienced Commercial Claims Examiner III based in the United States. Responsibilities include evaluating, investigating, and resolving complex commercial property claims, focusing on high-value losses above $500,000.

Role requires strong policy knowledge, fraud awareness, and coordination with independent adjusters and legal counsel. The position is full-time and remote, with emphasis on accurate settlements, reserves management, and compliance with regulatory

Qualifications

• Bachelor's degree or equivalent.
• 5+ years of property claims adjusting exp, incl. 2+ years in commercial property.
• 4+ years of commercial claims exp, incl. 2 years over $500,000.
• Understanding of insurance policy contracts, statutes, and claims processes.
• CEA and Fair Claims Settlement Practices certifications.
• Strong written and verbal communication, collaborating with adjusters, legal counsel, and stakeholders.
• MS Office knowledge (Word/Excel).
• Strong analytical, investigative, negotiation, and decision-making skills for complex claims.

Responsibilities

• Manage a portfolio of commercial property claims, mainly >$500k.
• Review adjuster investigations for coverage and validity.
• Evaluate reserves and authorize payments per adjuster recommendations.
• Investigate and adjust claims to support fair settlements.
• Collaborate with internal teams and legal counsel on litigation.
• Monitor adjuster files for guideline compliance.
• Analyze settlement data for accuracy and validity per procedures.
• Ensure compliance with DoI requirements and internal procedures.
• Identify fraud indicators and route cases appropriately.
• Negotiate settlements reflecting covered losses and insurer protection.

Skills

Communication skills

Negotiation

Analytical skills

Investigative skills

Decision making

Education

Bachelor's degree or equivalent

CEA Certification

Fair Claims Settlement Practices certification

Tools

Microsoft Office (Word/Excel)

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Commercial Claims Examiner III based in the United States. The Commercial Claims Examiner III is responsible for evaluating, investigating, and resolving complex commercial property insurance claims, with a primary focus on high-value losses exceeding $500,000. This role involves reviewing coverage, assessing claim validity, managing reserves, and authorizing payments and settlement recommendations. Working closely with independent adjusters, internal teams, and legal counsel, the examiner ensures claims are handled accurately, fairly, and efficiently. The position requires strong technical expertise in commercial property policies, claims procedures, and settlement practices. It also involves identifying potential fraud, maintaining regulatory compliance, and negotiating settlements that reflect covered losses while protecting the insurer's interests. This is a full-time remote opportunity for an experienced claims professional based in the United States.

Accountabilities

• Manage a portfolio of commercial property claims from initial assignment through final resolution, primarily handling claims exceeding $500,000.
• Review claims investigated by independent adjusters to assess coverage, verify claim validity, and determine appropriate resolutions.
• Evaluate and adjust loss reserves, review correspondence and reports, verify policy coverage, and authorize payment requests and recommendations submitted by independent adjusters.
• Investigate, assess, and adjust claims using technical expertise and strong interpersonal skills to support fair and timely settlements.
• Collaborate with internal stakeholders and legal counsel on claims involving litigation.
• Monitor independent adjuster files to ensure compliance with applicable guidelines and claims-handling standards.
• Analyze settlement data and supporting documentation to confirm the accuracy and validity of claims and ensure settlements follow established procedures.
• Maintain compliance with Department of Insurance requirements and internal claims procedures.
• Identify potential indicators of fraud or illegal activity and refer cases through the appropriate internal processes.
• Negotiate settlements promptly, ensuring that payments reflect covered losses while protecting the insurer from invalid claims.

Requirements

• Bachelor's degree or equivalent.
• At least 5 years of property claims adjusting experience, including preferably 2 or more years in commercial property claims.
• Four years of commercial claims experience, including 2 years handling claims exceeding $500,000.
• Comprehensive understanding of insurance policy contracts, applicable statutes, and claims processes.
• Certification in CEA and Fair Claims Settlement Practices.
• Strong written and verbal communication skills, with the ability to collaborate effectively with adjusters, legal counsel, and internal stakeholders.
• Working knowledge of Microsoft Office, particularly Word and Excel.
• Strong analytical, investigative, negotiation, and decision-making skills, with the ability to evaluate complex claims and recommend appropriate settlements.

Benefits

• Compensation: $46.15-$51.28; the source does not specify the pay period or currency.
• Work arrangement: Remote.
• Employment type: Full-time.