Claims Examiner

Client specializes in underwriting, insurance coverage for small businesses in a specific niche market. Insurance policies include GL, PL, Property & Casualty etc.

Competitive salary and performance-based incentives.
Comprehensive health, dental, and vision insurance plans.
401(k) retirement plan with company match.
Generous paid time off and holiday schedule.
Employee wellness programs and resources.

We are seeking a highly skilled and detail-oriented Specialty Claims Examiner to join our dynamic team. The ideal candidate will have a strong background in claims examination, with a focus on specialty insurance products. This role requires exceptional analytical skills, a thorough understanding of insurance policies, and the ability to navigate complex claims with professionalism and empathy.

Key Responsibilities:
Claims Evaluation: Review and analyze claims to determine coverage, liability, and damages. Ensure all claims are handled in accordance with company policies and regulatory requirements.
Documentation and Reporting: Accurately document claim investigations, findings, and decisions. Prepare comprehensive reports for internal and external stakeholders.
Customer Interaction: Communicate effectively with policyholders, claimants, and legal representatives. Provide clear and concise explanations of coverage, claim status, and settlement options.
Fraud Detection: Identify potential fraudulent claims and conduct thorough investigations to mitigate risk. Collaborate with the Special Investigations Unit (SIU) as necessary.
Negotiation and Settlement: Negotiate fair and equitable settlements with claimants and their representatives. Ensure timely and accurate processing of claim payments.
Continuous Improvement: Stay current with industry trends, regulations, and best practices. Participate in ongoing training and development to enhance expertise in specialty claims.
Qualifications:

Bachelor’s degree in Business, Insurance, or a related field.
Minimum of 5 years of experience in claims examination, with a focus on specialty insurance products.
Strong analytical and problem-solving skills.
Excellent written and verbal communication abilities.
Proficiency in claims management software and Microsoft Office Suite.
Ability to work independently and as part of a team in a fast-paced environment.
Exceptional attention to detail and organizational skills.
Professional certifications such as AIC, CPCU, or similar are a plus.