PROPERTY(Residential/ Commercial Insurance) Senior TPA Claims Examiner
12 hours ago
We are seeking an experienced Senior Property TPA Claims Examiner to become a part of our organization.
Duties and Responsibilities:
- Review/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
Qualifications
- 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
Salary and bonus program (if applicable) commensurate with experience.
Company DescriptionWe 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.Company DescriptionWe 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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