Sr. Commercial Claims Examiner

Our Sr. Commercial Claims Examiner enjoys robust benefits:

• Remote work schedule!
• Health & Wellness: Company-sponsored Medical, Dental, Vision, Life, and Disability Insurance (Short-Term and Long-Term).
• Financial Security: 401k Retirement Plan with a generous 9% match
• Work-Life Balance: Four weeks of PTO and Pet Insurance for your furry family members.

What you can expect as a Sr. Commercial Claims Examiner:

• * Verify facts of loss and pertinent information to analyze and confirm coverage.
• Establish ultimate reserves (anticipated cost to bring file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.
• Explain and appropriately respond to insured's, public adjusters, attorney's and contractors during telephone contacts; as well as, contact the appropriate parties to obtain any needed information, provide timely investigation status updates, explain settlements and/or ultimate claim disposition.
• Timely submit reserve and payment approval requests, as appropriate.
• Identifyclaims requiring a Reservation of Rights and refer for management approval.
• Formulate and execute appropriate ADR strategy in compliance with statutory guidelines.
• Check e-mails and messages daily. Respond to all calls, emails, and questions daily.
• Apply advanced negotiation skills to effectuate resolution of disputed claims with insureds or their legal representative.
• Coordinate appraisal process, maintain communication necessary to ensure appraisal process is moving forward in timely fashion.
• Draft denial letters for management approval.
• Identify and refer claims with subrogation potential to the subrogation department.
• Identify and refer cases with potential NICB fraud indicators.
• Virtually investigate and resolve claims, asappropriate, with the use of video technology.
• Close all files as appropriate in a timely and complete manner.
• Serve as mentor and/or trainer, as needed, to junior adjusters.
• Strictly adhere to Best Practices and operational guidelines, as well as all statutory requirements.
• Interfaces with company clients, carrier, adjusters, or covered parties. Communicates with agents regarding status of claim.
• Completes and/or reviews, approves, or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
• Resolves disputes regarding claims resolution. Responsible for reopening and re-evaluating claim, as necessary.
• Participates in litigation when applicable.

What we are looking for as a Sr. Commercial Claims Examiner:

• Bachelor's degree
• A minimum of 10 years of Commercial claims experience preferred.
• In-depth professional knowledge of all aspects of claims operations.
• Florida 520/620 license is required.
• Ability to obtain AL, GA, NC and SC adjusters licenses.
• Strong commercial coverage interpretation and claims handling background is required.
• Must have commercial construction knowledge and be proficient in Xactimate.

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