Claims Examiner III

2 weeks ago

Fort Worth, United States AmRisc Full time
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Regular or Temporary:
Regular

Language Fluency: English (Required)

Work Shift:
1st shift (United States of America)

Please review the following job description:

The incumbent is responsible for investigating, evaluating, negotiating, and resolving personal lines property claims. Responsible for adjusting major and complex losses in their entirety, including high dollar claims. May also adjust standard losses.

ESSENTIAL DUTIES AND RESPONSIBILITIES
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
1. Responsible for completing coverage investigations and coverage analysis and develop a detailed resolution plan.
2. Responsible for providing exceptional customer service and handles claims in accordance with prescribed authority and best claims practices.
3. Develop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to come to a resolution quickly and accurately.
4. Identify, analyze, and resolve coverage issues according to established Company protocol, including thorough policy review and analysis of application to the individual claim. With supervisor approval, negotiate with policyholders to settle claims of limited monetary value.
5. Develop and direct investigative plans. Conduct timely and detailed investigations that include scene investigation (e.g., photos, diagrams, blueprints, maps), statements, official reports (e.g., police, fire, weather, hail), and ownership documents (e.g., tax liens, judgments, encumbrances). Identify alleged and actual damages, identify potential liable parties, recognize and address potential fraud.
6. Conduct thorough damage development, leading to timely and adequate evaluations, including appraisals/estimates, business records, invoices, detailed inventory, purchase records, receipts, credit card statements, and ALE documents. Develop appropriate methods of repair/replacement, verify ownership, and apply any special limitations.
7. Establish voice to voice communication within 24 hours. Maintain effective communications with the Customer at all times. Consistently work within specific time limits and authority.
8. Maintain company reputation and integrity of insurance products by complying with federal and state regulations, Company protocol, and service standards. Maintain current knowledge of regulations and issues, industry activity, and trends.
9. Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities. Assist or prepare files for suit, trial, or subrogation.
10. Train and mentor lower level Examiners, as appropriate. May conduct Quality Audits.
11. Handle authority requests during the absence of a Supervisor.

QUALIFICATIONS
Required Qualifications:
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.
1. Five years of related, applicable experience
2. Associate's degree (A.A. or A.S.) or equivalent from a two-year college, business school, or technical school
3. Adjusters License for states in which the Company conducts business

Preferred Qualifications:
1. Eight years of related, applicable experience
2. Fluency in Spanish
3. Completion of a major insurance designation, or actively pursuing insurance related courses

General Description of Available Benefits for Eligible Employees of TIH:
All regular teammates (not temporary or contingent workers) working 20 hours or more per week are eligible for benefits, though eligibility for specific benefits may be determined by the division of TIH Insurance Holdings, LP (TIH) offering the position. TIH offers medical, dental, vision, life insurance, disability, accidental death and dismemberment and tax-preferred savings accounts, along with other voluntary benefits. All regularly scheduled teammates (not temporary or contingent workers), regardless of the number of scheduled hours, can contribute to a 401(k) savings plan and you become eligible for Company matching contributions after one year of service and attainment of age 21. Teammates also receive no less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during their first year of employment, along with 10 sick days (also prorated), and paid holidays. For more details on TIH's generous benefit plans, please visit our Benefits site. Eligible employees may have the opportunity to participate in a deferred compensation plan and/or have an ownership interest in TIH in the form of profits interest or capital interest. As you advance through the hiring process, you will learn more about the specific benefits available for any non-temporary position for which you apply, based on full-time or part-time status, position, and division of work.

This position is part of TIH.

Truist Financial Corporation has completed the sale of Truist Insurance Holdings (TIH). As a result, TIH is a separate company from Truist Bank as of May 6, 2024. Refer to the news release for details.

TIH Insurance Holdings, LP (TIH) supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. TIH is a Drug Free Workplace.

EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

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