Commercial Claims Examiner III (Remote)

California FAIR Plan Association; Los Angeles (CA); Remote; USD 90,000 - 120,000; Full time

Job summary

California FAIR Plan Association in Los Angeles is seeking a Commercial Property Examiner to review, evaluate and process complex commercial insurance claims. The role includes authorizing payments, reviewing forms, and ensuring settlements are accurate and compliant.

The candidate will handle claims over $500,000, collaborate with legal counsel, and maintain strict adherence to insurance guidelines and company procedures. Strong communication and MS-Office skills are required.

Qualifications

• Bachelor’s degree or equivalent.
• 5+ years of property claims adjusting experience, including 2+ years commercial property claims preferred.
• Excellent oral and written communication skills.
• Comprehensive understanding of policy contracts/statutes and claims processes.
• Certified in CEA and Fair Claims Settlement Practices.
• 4 years Commercial Experience, 2 years claims over $500k.

Responsibilities

• Manage a caseload of commercial property claims from assignment through resolution.
• Examine commercial claims investigated by independent adjusters to determine coverage.
• Review and adjust commercial loss reserves, verify coverage and authorize payments.
• Collaborate with internal personnel or legal counsel on claims involving litigation.
• Investigate, evaluate, and adjust claims to promote fair and prompt settlements.
• Oversee independent adjuster files to ensure CFP IA guidelines are followed.
• Verify data used in settlements to ensure validity and adherence to procedures.
• Maintain compliance with the Department of Insurance and company procedures.
• Identify fraud indicators and refer to the appropriate personnel.
• Negotiate settlements reflecting insured losses and insurer protection.

Job description

POSITION SUMMARY

The Commercial Property Examiner reviews, evaluates and processes complex commercial insurance claims and makes recommendations for resolution. Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other records to determine insurance coverage, ensuring payment recommendations and settlements have been made correctly.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Manage a caseload of commercial property claims from assignment through resolution.
• Examine commercial claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims.
• Review and adjust commercial loss reserves, correspondence, reports, verify coverage and authorize payments submitted by independent adjusters.
• Collaborate with internal personnel and/or legal counsel on claims involving litigation.
• Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
• Oversee independent adjuster files to ensure they have followed CFP IA Guidelines.
• Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures.
• Maintain compliance with the Department of Insurance and Company procedures.
• Identify fraud or illegal activity indicators and follow internal processes to refer the claims to the appropriate personnel for follow up.
• Promptly negotiates settlements ensuring the settlement reflects the insured losses while confirming the insurer is protected from invalid claims.

ADDITIONAL DUTIES AND RESPONSIBILITIES

The Commercial Claims Examiner III role will focus on Claims over $500,000 but may receive smaller claims as needed.

KNOWLEDGE AND SKILL REQUIREMENTS

• Bachelor’s degree or equivalent.
• 5+ years of property claims adjusting experience, including 2+ years commercial property claims preferred.
• Excellent oral and written communication skills.
• Working experience with MS-Office (especially Word and Excel).
• Comprehensive understanding of policy contract/statutes and claims processes.
• Certified in CEA and Fair Claims Settlement Practices.
• 4 years Commercial Experience, 2 years claims over $500k