Insurance Claims Examiner

2 weeks ago


Albuquerque, New Mexico, United States Amerind Full time
Job Summary

Evaluate property insurance claims for Commercial and Homeowner business lines, ranging from level 1 to level 3 total losses. Assess property claims for coverage and reach a resolution with the policyholder.

Key Responsibilities
  • Determine coverage evaluation, including establishing adjuster reserves, customer communication, and evaluating policy coverage.
  • Evaluate field reports of damage risk, obtain additional risk information, and input all risk information into the claim system.
  • Secure a resolution payment for the policyholder, prepare the claim file for closure, and communicate with customers and associates.
  • Investigate claims on-site, evaluate damages, complete coverage analysis, damage assessments, and cause/origin determination, and submit a field report with a narrative, estimate, photos, and any other pertinent information for the damages.
  • Determine property damage evaluation using Xactimate software, negotiate settlements, and approve supplement expenses.
  • Prepare declination letters when coverage is not applicable under the policy, prepare correspondence letters to policyholders with updates on their claims, and obtain any supporting documents for the claim file.
Requirements
  • An Associate Degree in Insurance, Economics, Business Administration, or a related field is required.
  • A bachelor's degree in insurance, Economics, Business Administration, or a related field is preferred.
  • Designations and certificates from accredited insurance institutions are preferred.
  • Minimum of three years of desk adjusting experience involving property claims preferred.
  • Minimum of three years of field adjusting experience using software applications such as Symbility, Xactimate, or Xactanalysis preferred.
  • A minimum of three years of carrier risk information system, such as Guidewire or Sapiens, is preferred.
Knowledge and Skills
  • Knowledge of applicable federal, state, tribal, and local laws, regulations, and requirements.
  • Knowledge of property, auto, and liability insurance laws, policies, and regulations.
  • Knowledge of medical and insurance terminology, and of claims processing practices.
  • Knowledge of Homeowner and Commercial policy forms.
  • Ability to successfully obtain certificate(s) in Property Technical Certificate (PTC upon employment.
  • Ability to interpret insurance policies, claim procedures, and federal and state regulations.
  • Ability to communicate effectively in the English language, both verbally and in writing.
  • Ability to analyze situations and adopt appropriate courses of action.
  • Ability to work effectively under stressful conditions.
  • Ability to interact and maintain good working relationships with individuals of varying social and cultural backgrounds, employees and officials.


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