Senior Claims Examiner

ESSENTIAL FUNCTIONS

• Demonstrates a customer centric attitude
• Analyzes and manages claims by verifying coverage and investigating and gathering pertinent information to determine the exposure on the claim
• Maintains well-developed action plans for an appropriate and timely resolution in accordance with established policies and procedures
• Recognizes and properly addresses coverage issues, potential fraud, and subrogation potential
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim
• Conducts detailed damage and bill reviews and controls claim expenses
• Pays and processes claims within designated authority level or denies payments where no coverage, liability, or compensability exists
• Enters claim payments and reserves on claims on computer system, inputting concise and accurate file documentation
• Communicates decisions in a clear and professional manner
• May provide training, coordination, and investigation of potential fraudulent activity for the Association

REQUIRED EDUCATION AND EXPERIENCE

• Bachelor’s degree or 6+ years of relevant work experience
• Texas Adjuster License
• This position requires the Sr. Claims Examiner to obtain the Associate in Claims designation within two years of the date of hire/promotion, or the Chartered Property Casualty Underwriter designation within three years of the date of hire.

PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES

• Bilingual, preferably Spanish and/or Asian Languages (such as Mandarin, Vietnamese, etc.)
• Building contractor, roofing contractor, restoration contractor background
• Residential/Commercial Property estimating software

PHYSICAL REQUIREMENTS

• The position requires the ability to sit, hear, converse over the telephone, and key frequently on a computer for long periods of time
• This position may require extended hours, overnight travel, and remote work outside the office as part of our Organization-wide efforts to respond to high claim volume caused by catastrophic storm events.

Benefits

The Association offers a comprehensive and competitive benefits package designed to support both your professional success and personal well-being. A key highlight of our offering is a fully remote work environment, allowing you to contribute from home with no relocation required.

In addition to our benefits, Texas Windstorm Insurance Association fosters a collaborative and mission-driven work environment where employees are valued, supported, and encouraged to grow. Our teams work closely across departments, promoting transparency, innovation, and a shared commitment to serving our policyholders and communities.

Employees also enjoy:

• Comprehensive medical, dental, vision, group life, AD&D, and dependent life insurance coverage
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) with a generous annual HSA employer contribution
• A 401(k) retirement plan with employer matching contributions up to 6%, in addition to a pension plan that begins vesting at 5 years of employment
• Active support for professional growth, including ongoing training and professional development opportunities sponsored by TWIA, support to obtain professional certifications, and a tuition reimbursement program
• Generous paid time off, including vacation, sick leave, paid holidays, and personal days
• Flexible scheduling to support work-life balance