Claims Adjuster

About This Role

The Claims Adjuster I reviews claims related to property damage or loss, working with various experts to obtain accurate assessments and support claims decisions. This position partners with Claims Trainers and leadership to interpret insurance policy terms and conditions to determine coverage and exclusions. The role also involves engaging with policyholders to gather information, provide updates, and explain the claims process and decisions.

Responsibilities

• Maintain accurate and detailed notes regarding interactions, decisions, and actions taken throughout a claim
• Partner with Claims Team Lead and Trainers to review, evaluate, and investigate photos, estimates, forms, receipts, inspection reports, and official reports presented on a claim
• Review, partner, and process property damage claims submitted by policyholders
• Review insurance policies to determine coverage by working with Claims Trainers and leadership to interpret and apply policy provisions to claims under consideration based on coverage and investigation findings
• Conduct, record, and interview those insured to secure information regarding personal loss
• Work with claimants or representatives of claimants (contractors, public adjusters, attorneys, or other legal representatives) to gather necessary information regarding the claim and to negotiate fair and equitable settlements, overseen by Claims Team Lead
• Collaborate with other insurance carriers as needed regarding duplicate claims and coverage
• Select and assign claims for inspections
• Request and issue settlement checks with explanation letters based on policy terms and investigation findings, with limited authority
• Prepare and issue denial letters to claimants, clearly outlining the reasons for denial based on policy terms and investigation findings
• Identify potential fraudulent claims and refer for additional investigation as warranted
• Ensure claims handling complies with company and regulatory policies
• Escalate complex insurance claims to management and legal teams including those subject to complaints and litigation
• Consult with Claims Team Leads to resolve disagreements with a claim, utilizing alternative dispute resolutions (arbitration, appraisal, and mediation)
• Collaborate with management on arbitration, appraisal, and mediations
• Maintain workflow to ensure timely processing of claims
• Partner with Claims leadership on difficult or unusual situations that arise on claims
• Prepare response letters to complaints or legal issues received
• Provide excellent customer service by maintaining professional and constant dialogue with claimants in addition to handling claims promptly, efficiently, and with empathy
• Communicate regularly with policyholders or other relevant parties providing updates on the status of claims and addressing any questions or concerns