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Insurance Claims Examiner

2 months ago

Bakersfield, California, United States Direct Auto Full time
Job Summary

We are seeking a highly skilled and detail-oriented Homeowners Claims Adjuster to join our team at Direct Auto Insurance. As a Claims Adjuster, you will be responsible for examining claims data, investigating losses, determining coverage and liability, and adjusting claims within the limit of authority.

Key Responsibilities
  • Receive and verify claim assignments, gathering facts and evidence to document all relevant information
  • Determine claim approval and denial up to $7,500 per exposure or $10,000 per file
  • Establish investigative plans, initiate investigations, complete reports, and review loss reserves and adjust or open hidden exposures as necessary
  • Evaluate and adjust claims within the limit of authority
  • Evaluate settlement alternatives, reviewing regulatory compliance and fair claims practices, and make decisions on the best option
  • Make appropriate contacts to discuss settlements, extend offers, and document all file activity and payment/settlement information
  • Determine subrogation or fraud potential and refer to the Unit when necessary
  • Participate in investigations of medical providers and attend EUOs for PIP claims
  • Work with attorneys to resolve lawsuits
  • Conduct negotiations and settlements within authority levels, using independent judgment
  • Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
  • Assist in training of Claims Representatives
  • Perform other projects and assignments as directed
Requirements
  • Bachelor's Degree or equivalent education, training, and work-related experience
  • Successfully completes Claim Representative trainee program or equivalent external training program
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Obtain and maintain appropriate licensing or educational requirements
  • Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
  • Demonstrate proficiency in file audits to agreed standards of efficient claims quality
  • Has a solid command of claims policies and procedures, exhibiting basic interpretation of policies and procedures in resolving claims
  • Demonstrate the ability to interpret and apply written coverage accurately to establish claims and determine action plans
  • Demonstrate a solid understanding of the repair and replacement of property damages, including mechanical components of a vehicle, homeowner damages, and other potential exposures
  • For claims involving injuries, has a solid understanding of how to review, evaluate, and negotiate injury claims
  • Demonstrate ability to handle litigation in accordance with company guidelines and recognize legal issues
  • High degree of initiative, mature judgment, and discretion
  • Ability to resolve conflicts and empathize with customers is critical
  • Strong negotiation skills
  • Demonstrate professional oral and written communication skills
  • Organization and time management skills are critical for this position
  • Demonstrate an understanding of insurance law as it relates to claims
Desired Skills
  • Demonstrates a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
  • Demonstrates an understanding of the functions of other departments, such as Policy Ops and Marketing

Direct Auto Insurance is an Equal Opportunity (EO) employer. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law.