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Sr. Commercial Claims Examiner
2 months ago
Join our dynamic team of innovators, creators, and problem solvers At Frontline Insurance, we're on a mission to Make Things Better We believe in fostering a collaborative, inclusive, and growth-oriented work environment where every team member can thrive and make a meaningful impact.
At Frontline Insurance we're more than just a workplace – we're a community of talented individuals dedicated to Integrity, Patriotism, Family and Creativity. Join us in shaping the future of Insurance and let's achieve remarkable things together. Your next career adventure starts here
SUMMARY
The Senior Commercial Claims Specialist will assist policyholders throughout the entire claims process. Ability to work extended hours, including evenings and weekends, based on customer and business needs, (e.g. in response to claim volume fluctuation due to catastrophic weather) may be required.
The Senior Commercial Claim Adjuster will handle a caseload which encompasses all levels of complexity for first-party claims, including establishing facts of loss, conducting proper reserve and coverage analysis, assessing and estimating property damage, assigning experts as needed, identifying potential fraud and timely investigate claim for proper resolution. The Senior Commercial Claim Adjuster will also serve as a mentor to junior adjusters and assist with training, as needed.
Successful candidate must be able to attend trainings and assist management with other duties and responsibilities, as requested.
Knowledge of insurance regulations claims practices and statutory requirements, governing case law, ADR methodology, DFS mediation and disputed claims resolution is required.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- 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.
- Identify claims 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, as appropriate, 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.
SUPERVISORY RESPONSIBILITIES
This position has no supervisory responsibilities.
EDUCATION and/or EXPERIENCE
- 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.
CERTIFICATES, LICENSES, REGISTRATIONS
- Florida 520/620 license is required.
- Ability to obtain AL, GA, NC and SC adjusters licenses
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level if internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
LANGUAGE SKILLS
Must possess the ability to read and comprehend detailed instructions, correspondence, and memos as well as write simple correspondence. Must also be able to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
MATHEMATICAL SKILLS
Must be proficient with the following: addition, subtraction, multiplication, and division in all units of measure, using whole numbers, common fractions, and decimals.
REASONING ABILITY
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
NOTE: This is not necessarily an exhaustive list of responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, Frontline Insurance reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed when circumstances change.
I have carefully read and understand the contents of this job description. I understand the responsibilities and duties expected of me. I also understand that this job description does not constitute a contract of employment nor alter my status as an at will employee. I have the right to terminate my employment at any time and for any reason and Frontline Insurance has a similar right.
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