Key Responsibilities:
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Investigate claims by verifying facts through policy review, endorsements, and interviews with insured parties and other relevant individuals, and write estimates or denial based on coverage determination.
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Review documentation for completeness, accuracy, and compliance with carrier policies
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Ensure all collected information is accurate and identify potentially fraudulent activity, following up on discrepancies
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Set appropriate reserves and recommend reasonable and accurate claim payments in a timely manner
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Adhere to carrier Service Level Objectives (SLOs) and claim closure requirements
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Draft and deliver clear, professionally written correspondence, including claim-related letters and communications
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Exercise sound judgment and critical thinking to resolve complex claim issues
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Communicate effectively and promptly with insureds, claimants, and internal stakeholders in a courteous and professional manner
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Maintain detailed, organized file documentation to support the claim; when needed, make revisions and/or collaborate on files
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Serve as technical subject matter expert and support team members by sharing knowledge and assisting with workload when needed
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Prepare and submit all required claim documentation in a timely manner.
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Provide regular updates on claim status to management and leadership and escalate to management when necessary following established procedures.
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Attend and participate in training sessions, team meetings, and projects as needed.
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Deliver excellent customer service and maintain a high level of professionalism in all interactions.
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Adhere to all applicable State Insurance Regulation requirements and other applicable laws, regulations, and standards
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Assume personal responsibility for maintaining the requisite state license for the state(s) assigned.
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Perform additional duties as assigned
Qualifications:
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High School Diploma or equivalent
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Minimum of two years’ experience in claim handling, estimating, and policy interpretation required
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Experience handling claims in the California market is a plus
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Proficient with complex claims handling procedures preferred
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Must have experience handling weather water and non-weather water perils
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Must be familiar with water mitigation practices
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Proficient in Xactimate, Snapsheet and Guidewire CMS experience is a plus.
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Proficient in writing estimates over the phone and from various sources
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Proficient computer skills with Microsoft Word, Excel, PowerPoint, and Adobe Acrobat
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Experience with taking recorded statements is a plus
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Strong focus on customer service.
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Self-motivated, and critical thinker who can work independently and use sound judgment to solve problems
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Strong written and verbal communication skills
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High level of time management skills
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Ability to multitask and quickly adapt to changing/conflicting priorities
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Excellent attention to detail
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Strong relationship building skills and ability to work well with others
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Possess the requisite state license for the state(s) assigned.
Physical Activities and Requirements
Work involves prolonged periods sitting at a desk; continuously working on a computer using manual dexterity; operating office equipment, cell phone usage, walking, face to face discussions and web-based meeting participation. Continuously requires vision, hearing and communication.
Schedule Availability
Willingness to work a varied schedule, as needed; may require weekend work days and accommodation of occasional meetings and work activities scheduled outside normal business hours
Salary: $50,000 + commission
