Claims Examiner II - Remote

Experienced Recruiting Partners - Columbia, SC

Manages a pending caseload of moderate severity and complexity property and/or liability homeowner claims in a team environment. Ensures prompt, effective, and courteous handling of all claims to policyholders and claimants. Participates in the after-hours phone program on a rotational basis. Special emphasis is placed on complying with appropriate guidelines.

ESSENTIAL FUNCTIONS:

  • Claim Assignment - Verifies policy information for accuracy to determine if coverage is in force and applicable on new claims. Develops an investigative action plan to include resolution of coverage issues as required.
  • Manages Customer Contact: Ensures timely and professional contact is made with insured, claimants, agents and other parties to include prompt return of phone calls. Contacts or interviews necessary parties to secure additional information such as public adjusters, attorneys, engineers and other vendors.
  • Investigation - Evaluates assigned claims on an ongoing basis and makes recommendations for further task assignments and other information as needed for proactive claim handling and final claim disposition. Interprets policy provisions to approve or deny payments applying technical knowledge to effect fair and prompt claim settlements. Determines when cases need to be elevated to a higher level. Presents information in a thorough manner and participates in their discussion when escalated.
  • Reserving - Ensures claims are adequately and timely reserved by adjusting reserves or providing reserve recommendations to ensure that reserve activities are consistent with established guidelines.
  • Reporting –Prepares large loss reports on claims excess office authority for manager review and escalation. Presents cases and participates in their discussion at claim committee meetings.
  • Processing - Reviews new claims, claim payments, reserves on computer system and corrects information as needed by inputting data in a concise, accurate and complete manner. Pays and processes claims within designated authority level.
  • Resolves moderate severity level claims using high service-oriented file handling techniques as defined by established guidelines.
  • Negotiation and Settlement: Within assigned authority limits, negotiates and settles claims with policyholders, claimants, public adjusters, attorneys, AOB and other vendors.
  • Diary and File Review – Maintains current Diary, Workplan, and Activities via the Guidewire Claim System, updating status once reviewed and/or completed. Ensures all Workplan items are current prior to escalation for authority. Creates a Plan of Action “POL” for outstanding activities at diary review. Ensures reports and other documents are attached to the file timely and named appropriately. Conducts periodic spot checks of claim files not being followed in a regular diary to ensure compliance with internal and external procedures and guidelines.
  • Strong oral and written communication skills used to interact with all levels of internal and external customers.
  • Active and attentive listening skills.
  • Establishes and maintains effective relationships.
  • Ability to interact with others to identify issues/problems and to correct problems.
  • Knowledge of principles and processes for providing customer service to include customer needs assessment, meeting quality standards for service, and evaluation of customer satisfaction.
  • Self-directed.
  • Ability to prioritize tasks and work with multiple priorities.
  • Effective and timely decision-making skills.
  • Strong investigative and negotiation skills.
  • Ability to quickly gain a thorough knowledge and understanding of the homeowner policies and endorsements is critical.
  • Attention to detail with a high level of accuracy.

REQUIREMENTS:

  •  4-year college degree preferred plus 3 to 4 years of property and /or liability (homeowners) claims handling experience, or a comparable combination of education and experience.
  • Adjusters license required in the states in which the position handles, including completing the requisite continuing education requirements.
  • Proficient in Microsoft Office Suite.
  • Proficient knowledge of Estimating software.
  • Demonstrated knowledge of property insurance contracts and the ability to analyze coverage questions.
  • Insurance certificates, courses, or professional designations a plus.
  • Construction knowledge preferred.


Posted On: Monday, July 5, 2021



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