Claims Examiner - Complex

About the role

CITON Claims Solutions, LLC is seeking a Claims Examiner - Complex to join our team in Melbourne, Florida or Dallas, Texas. This role involves investigating, evaluating, and resolving insurance claims, with a focus on handling complex litigated claims, mediations, appraisals, and claims involving other 3rd parties.

Responsibilities

• Review Claims: Assess and analyze submitted claims documentation to determine validity and coverage.
• Gather Essential Information: Communicate with policyholders, witnesses, and other involved parties to collect relevant details for claims evaluation.
• Create Detailed Reports: Document findings thoroughly and prepare thorough reports with findings and well-supported recommendations for claim settlements.
• Negotiate Settlements: Work with policyholders and third parties to negotiate settlements that ensure fair and just outcomes.
• Handle Disputes: Handle disputes professionally and efficiently, ensuring favorable resolutions.
• Maintain Clear Communication: Foster transparent and professional communication with policyholders and all stakeholders throughout the claims process.
• Collaborate Across Teams: Partner with internal teams, including underwriters and legal advisors, to resolve complex claims.
• Ensure Compliance: In all claims processes, comply with state and federal regulations and company policies.
• Support Catastrophe Response: Provide critical support for claims management efforts during disaster events as needed.

Requirements

• Experience: Minimum of 7+ years in a claim adjusting role, with direct experience handling litigated claims, mediations, appraisals, and claims involving other 3rd parties. Experience handling Florida property claims is strongly preferred.
• Technical Skills: Proficiency with CMS, Microsoft Suite of products, strong analytical, investigative, and problem-solving skills; solid understanding of legal concepts surrounding liability claims.
• Licensing and Certifications: Valid adjuster’s license in home state and Florida required.
• Insurance Knowledge: Strong understanding of insurance policies, coverage evaluation, claim investigation, and dispute resolution throughout the life of a file. Should be able to demonstrate advanced understanding of all issues related to liability claims including state regulations, case law, and statutes.
• Negotiation Skills: Excellent negotiation and communication skills, with proven ability to manage complex conversations and drive fair claim resolution with insureds, vendors, attorneys, and public adjusters.

Qualifications

• Valid adjuster’s license in home state and Florida required.
• Strong analytical, investigative, and problem-solving skills.
• Advanced understanding of legal concepts surrounding liability claims.
• Proven ability to handle complex conversations and drive fair claim resolution.
• Strong understanding of insurance policies, coverage evaluation, claim investigation, and dispute resolution.
• Ability to demonstrate advanced understanding of liability claims including state regulations, case law, and statutes.

Skills

• Proficiency with CMS, Microsoft Suite of products.
• Strong analytical, investigative, and problem-solving skills.
• Solid understanding of legal concepts surrounding liability claims.
• Excellent negotiation and communication skills.
• Advanced understanding of liability claims including state regulations, case law, and statutes.

Benefits

• Dynamic Environment: Thrive in a fast-paced, collaborative, and results-driven office where your contributions make a real impact.
• Career Growth: Opportunities for professional development and advancement within a supportive company culture.

Pay

• Competitive compensation package.

Schedule

• Regular office hours.
• Occasional extended schedules depending on company or departmental needs, project requirements, or customer demands.

Company Information

CITON Claims Solutions, LLC is a leading provider of claim management and administration services tailored specifically for insurance companies. We are proud to call two vibrant cities home: our headquarters on Florida’s stunning Space Coast in Melbourne and our Irving, Texas location.