The Sr Claims Examiner is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision.
- Analyzes insurance policies and other documents to determine insurance coverage.
- Investigates and analyzes claim information to determine extent of liability.
- Handles claims 1st Party Property Claims with complex to major severity.
- Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
- Sets timely, adequate reserves in compliance with the company's reserving philosophy.
- Engages experts to assist in the evaluation of the claim.
- Monitors vendor performance and controls expense costs.
- Evaluates, negotiates and determines settlement values.
- Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
- Handles all claims in accordance with Best Practices.
- Responsible for monitoring and completing assigned claims inventory.
- Acquire and maintain a state adjuster's license and meet state continuing education requirements.
- Provides Best-In-Class customer service for insureds and agents.
- Develops and maintains relationships with external and internal stakeholders.
- Acts as a mentor for less experienced Claims Examiners.
- Updates and maintains the claim file.
- Identifies opportunities for subrogation and ensures recovery interests are protected.
- Identifies fraud indicators and refers files to SIU for further investigation.
- Participates in claims audits, internal and external.
- Provides oversight of TPAs
- Assists with special projects
- SME for a developing Claims Department
Education & Experience:- Bachelor's degree or equivalent work experience
- 10+ years of claims adjusting experience, including at least 5 years handling both commercial and residential property claims
- Emphasis on Florida claims to include the involvement of Assignment of Benefits, Public Adjusters, and Attorneys
- Florida resident preferred
- Insurance designations preferred
- State adjuster licenses preferred
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