Sr. Claims Examiner

Duties and Responsibilities

• Handle daily residential and commercial property claims, CAT claims, and complex claims across Florida, Louisiana, and Texas in accordance with state regulatory requirements and company guidelines.
• Investigate claims thoroughly to confirm cause of loss, determine coverage based on applicable policy terms and conditions, and identify when a field adjuster, independent adjuster, or other expert is needed.
• Review and analyze repair estimates to determine what is covered, reasonable, and consistent with the scope of loss; negotiate settlements accordingly within authority level.
• Prepare and issue coverage determination letters, reservation of rights letters, denial letters, follow-up correspondence, and response letters in a professional and timely manner.
• Congduct thorough recorded statements from insureds, claimants, and witnesses as appropriate during the claims investigation process.
• Maintain proper reserves throughout the lifecycle of each claim, adjusting as new information is obtained.
• Collaborate with field adjusters, independent adjusters, and contractors; provide clear directions and establish productive working relationships.
• Handle claims involving attorney representation and public adjusters professionally, including responding to demands and ability to negotiate favorable resolutions.
• Communicate coverage decisions clearly and effectively to all parties, both verbally and in writing.
• Investigate and pursue subrogation opportunities; understand and manage liability-related claims.
• Maintain accurate, thorough, and timely claim file documentation within the claims management system (CMS).
• Work with defense counsel on litigated files and manage associated legal expenses.
• Deliver exceptional customer service through professional and timely communication via phone, email, and written correspondence.
• Other tasks and projects as may be assigned consistent with the responsibilities of this role.

Qualifications

• Minimum of 5 years of experience handling residential and commercial property and casualty insurance claims, including daily claims, CAT claims, and complex claims, with demonstrated proficiency in the duties outlined above.
• Florida All Lines Adjuster (620) License required; multi-state licensure preferred.
• Associate’s degree minimum; Bachelor’s degree preferred; or an equivalent combination of education and directly related claims experience.
• Strong knowledge of residential and commercial property insurance policy language, coverages, and endorsements, coverages, and exclusions.
• Proven ability to review and analyze repair estimates and understand what is covered, reasonable, and appropriate.
• Excellent letter writing skills with experience preparing coverage letters, denial letters, reservation of rights letters, and response correspondence.
• Ability to conduct professional and thorough recorded statements.
• Experience handling claims involving attorneys, public adjusters, and represented parties.
• Strong investigative skills with the ability to confirm cause of loss and identify when specialized expertise is required.
• Exceptional organizational skills with the ability to manage multiple claims simultaneously and meet deadlines.
• Excellent verbal and written communication skills with the ability to interact professionally with internal and external stakeholders.
• Knowledge of state-specific compliance requirements for Florida, Louisiana, and Texas.
• Knowledge and experience with Xactware/Xactimate products strongly preferred.
• Operational proficiency with MS Office products required.
• Bilingual preferred; written and verbal proficiency in a second language is a plus.