Job Description

Key Responsibilities:

• 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.
• Review documentation for completeness, accuracy, and compliance with carrier policies
• Ensure all collected information is accurate and identify potentially fraudulent activity, following up on discrepancies
• Set appropriate reserves and recommend reasonable and accurate claim payments in a timely manner
• Adhere to carrier Service Level Objectives (SLOs) and claim closure requirements
• Draft and deliver clear, professionally written correspondence, including claim-related letters and communications
• Exercise sound judgment and critical thinking to resolve complex claim issues
• Communicate effectively and promptly with insureds, claimants, and internal stakeholders in a courteous and professional manner
• Maintain detailed, organized file documentation to support the claim; when needed, make revisions and/or collaborate on files
• Serve as technical subject matter expert and support team members by sharing knowledge and assisting with workload when needed
• Prepare and submit all required claim documentation in a timely manner.
• Provide regular updates on claim status to management and leadership and escalate to management when necessary following established procedures.
• Attend and participate in training sessions, team meetings, and projects as needed.
• Deliver excellent customer service and maintain a high level of professionalism in all interactions.
• Adhere to all applicable State Insurance Regulation requirements and other applicable laws, regulations, and standards
• Assume personal responsibility for maintaining the requisite state license for the state(s) assigned.
• Perform additional duties as assigned

Qualifications:

• High School Diploma or equivalent
• Minimum of two years’ experience in claim handling, estimating, and policy interpretation required
• Experience handling claims in the California market is a plus
• Proficient with complex claims handling procedures preferred
• Must have experience handling weather water and non-weather water perils
• Must be familiar with water mitigation practices
• Proficient in Xactimate, Snapsheet and Guidewire CMS experience is a plus.
• Proficient in writing estimates over the phone and from various sources
• Proficient computer skills with Microsoft Word, Excel, PowerPoint, and Adobe Acrobat
• Experience with taking recorded statements is a plus
• Strong focus on customer service.
• Self-motivated, and critical thinker who can work independently and use sound judgment to solve problems
• Strong written and verbal communication skills
• High level of time management skills
• Ability to multitask and quickly adapt to changing/conflicting priorities
• Excellent attention to detail
• Strong relationship building skills and ability to work well with others
• 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