Senior Property Claims Examiner

4 weeks ago

Peachtree Corners, Georgia, United States PLS Claims Full time
Job Title: Senior Property Claims Examiner

We are seeking an experienced Senior Property Claims Examiner to join our team at PLS Claims.

Key Responsibilities:

  • Review and analyze issued insurance policies for submitted claims to identify and interpret coverage and make timely coverage decisions.
  • Promptly communicate with insureds, claimants, retail agents, general agents, independent adjusters, and attorneys as appropriate.
  • Document plan of action in the claim system and set appropriate diaries to continually drive claims toward prompt resolution and closure.
  • Determine the need on a per-claim basis for outside services (adjusters, experts, etc.), and provide written assignment instructions to the appropriate parties accordingly.
  • Monitor developments and hold assigned service providers accountable for timeliness, adherence to assigned tasks, and quality service.
  • Establish and maintain accurate loss and loss expense reserves.
  • Review reports from independent adjusters/other service providers for accuracy and completeness.
  • Strategize and take prompt action to obtain proper claim results in accordance with best claim practices.
  • Process claim settlements for smaller and less complex claims. Provide recommendations on larger claim settlements or denials and obtain required authorities when necessary.
  • Prepare claim correspondence that includes Assignment Instructions, Non-Waiver Agreements, Reservation of Rights, Denial letters, Sworn Statements in Proof of Loss, Statements of Loss, and explanatory letters when appropriate, obtaining required authorization when needed.
  • Maintain timely, accurate, well-organized, and complete records of claim activity and correspondence both sent and received in the claim system.
  • Identify subrogation target opportunities and lead recovery efforts.

Requirements:

  • Minimum of 3 years of first-party property adjusting experience.
  • Must possess, or have the ability to immediately obtain, a GA Adjuster License and other state Adjuster License(s) as required.
  • Adequate working knowledge of insurance industry standards and insurance claims, particularly residential and commercial property claims, property policy construction, ISO Commercial Property forms, and property insurance coverage evaluation/interpretation.
  • Commitment to continued learning and ongoing insurance education.
  • Exceptional communication (both written and verbal), influencing, evaluation, negotiating, listening, and interpersonal skills.
  • Proficiency with MS Word, MS Excel, MS Outlook.
  • Ability to learn new IT applications, such as TPA claim systems.
  • Ability to critically evaluate policy coverages against claim circumstances/loss information developed and promptly act.
  • Familiarity with Xactimate estimates and valuations, and the ability to modify if needed.
  • Outstanding organizational skills and ability to effectively maintain a diary system.
  • Customer-focused attitude to quickly and effectively respond to inquiries.
  • Ability to properly handle a full case load in a fast-paced environment with minimal supervision.
  • Ability and willingness to commit to extended schedules following significant catastrophe losses or during other periods of unusually high claims volume.
  • Bachelor's degree preferred.
  • TPA experience a plus.
  • Insurance designations (AIC and CPCU) are a plus.
  • Litigation experience (except worker's compensation) is also a plus.

About PLS Claims:

We are an independent adjusting company headquartered in the Atlanta area and represent numerous clients, including insurance companies, Syndicates at Lloyds, self-insureds, and third-party administrators. We have been providing services for over 27 years.

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