Sr. Claims Examiner

Property Claims – Desk Examiner (Level I, II, III, & Sr.)

Considering Applicants at all experience levels.

Salary $60,000 to $85,000 depending on experience.

Priority given to candidates located in Jacksonville, FL, Omaha, NE, and Jericho, NY. Remote positions available in all other markets.

Join our hardworking, collaborative team where your contributions will be celebrated and valued.

Why Stillwater? We're a national insurance provider that offers a full suite of insurance products and services. We strive to be the most respected insurance provider in the United States and that respect starts with our employees.

SUMMARY:

Investigate homeowner property insurance claims to determine the extent of the company's liability. Capable of independent claim examination with minimal supervision.

DUTIES AND RESPONSIBILITIES:

The following reflects management's definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

Duties for this position include:

• Determine coverage via verification and detailed analysis of applicable policy/endorsement contract language in comparison to case facts:
  1. Promptly resolve all open coverage issues through the investigation process.

• Protect the company's coverage defenses by timely drafting and issuing the appropriate Reservation of Rights, or Denial position letters in conformance with Unfair Claim Practice Act and/or Insurance Regulation Code.

1. Recommend pre-emptive actions, when needed, to resolve disputed coverage situations.

• Protect corporate assets through the timely and adequate case and expense reserving practices:

• Determine case values based upon claims handling experience, damage documentation, legal liability, causation, and jurisdictional issues.
• Monitor and ensure the earliest possible reserve adequacy on each case and document reserve rationale.

• Timely initiate, conduct, and complete an objective investigation into the case facts, coverage, claimed damages, and legal liability on all claims or business activities assigned and/or transferred:

• Complete detailed investigations, at appropriate levels for the individual cases, for the questions, issues, documents, experts needed, and tasks involved to accomplish or facilitate a prompt investigation.
• Determine whether the field investigation will be completed internally or complete a cost justification for hiring an independent firm.
• Provide written task instructions and supervision to independent investigators and adjusting firms or experts hired.
• Ensure claim files contain sufficient documentation to justify all coverage, legal liability, and damage decisions.
• Recognize and apply Fraud indicators and, if needed, refer the file to the S.I.U. unit timely.
• Identify and initiate timely pursuit of all subrogation and salvage recovery opportunities.

• Negotiate the resolution of covered claims at the earliest possible opportunity based upon a timely and complete evaluation of coverage, factual evidence, legal liability, and damages:

• Complete ongoing evaluations on damage values and comparative fault analyses as information is received.
• Consider all tort reform updates in the analyses of claims assigned.
• Determine excess of policy internal limits exposures and timely notify policyholders of such exposures.
• Complete detailed negotiation plans, identifying case strengths and weaknesses where coverage and/or damage disputes arise.
• Dispute resolution recommendations.
• Recommend mediation conferences when telephone negotiations are unsuccessful.
• Attend Mediation conferences when needed.

• Follow supervisory guidance on managing the legal expenses of defending and resolving lawsuits as well as avoidance of unnecessary litigation:

• Handling of disputed claims to include settlement involving AOBs, CRNs, NOIs, demands, or complex scope and price disputes.

• Draft and timely complete the necessary case narrative reports to the claim files, reinsurers, and claims management:
• Ensure claim administration standards are met:

• Ensure initial reserves reflect potential exposure based on preliminary factual development and ensure timely reserve changes are posted based upon investigative findings.
• Comply with all Unfair/Fair Claim Practice Acts and Insurance Code Regulations.
• Ensure accuracy of system loss description, cause of loss codes, and financial transaction codes for proper information to underwriting and statistical bureau reporting.
• Operate within established file aggregate authorities for reserve and payment levels, securing the appropriate management level approvals above established authority.
• Timely draft appropriate responses to the Insurance department and/or Consumer complaints.

• Achieve excellent customer service levels:

• Be courteous, polite and honor all commitments.
• Manage and diffuse conflict in adversarial situations.
• Attempt to return all phone/voice mail messages the same day as received, and not longer than twenty-four hours.
• Assist claim staff and customers with participating on the after-hours call roster.

• Perform a variety of miscellaneous duties and special projects as assigned, inclusive of Catastrophe duty and attending mediation if needed.

• Maintain staff adjuster licenses and complete continuing education requirements as required by the States assigned.

1. Develop excellent knowledge of company Best Practices and adhere to company policies.

QUALIFICATIONS:

• Bachelor's Degree (BA) from a four-year college or university, and related experience and/or training, or equivalent combination of education and experience.
• Exceptional knowledge of property and casualty policies, insurance principles, loss reserving, and development skills.
• Excellent knowledge of the civil legal environment structure and litigation management practices.
• Sound business judgment and effective human relations, problem solving, and analytical skills.
• Excellent expense management skills.
• Excellent knowledge of legal theories, contract law, policy construction rules, and defenses available.
• Excellent knowledge of each state's Unfair Claim Practice Act and Insurance Codes.
• Exceptional knowledge of damage estimating and repair techniques for tangible property, contents, and residential construction.
• Exceptional investigation skills.
• Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Proficient in the database, spreadsheet, and internet software, project management, and word processing software.
• Excellent customer service skills.
• Excellent verbal and written communication skills.
• Strong organizational skills; able to manage priorities and workflow.

• Must be able to speak, read, write, and understand the primary language(s) used in the workplace.

• Acute attention to detail.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.

COMPETENCIES:

• Problem Solving - Identifies and resolves problems promptly; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

• Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.

• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

REPORTING RELATIONSHIP:

Reports directly to Claims Supervisor.

Apply today to start your journey of being celebrated and valued with Stillwater Insurance Group.

Offer for employment is contingent upon the favorable responses from both a background investigation and a pre-employment drug screen.

Stillwater Insurance Group is a drug-free workplace and an equal opportunity employer.