California FAIR Plan Association Benefits Overview

Supervises property claims examiners, ensuring accurate coverage evaluations, compliant investigations, timely payments, proper reserves, and fair settlements. Reviews claim files, correspondence, field adjuster work, and diaries; authorizes claims within authority limits; supports litigation, appraisal, mediation, and questionable-claim investigations. Coaches examiners, coordinates with management and legal counsel, and leads quality and efficiency improvement projects while ensuring compliance with insurance regulations and company procedures.

Analyzes and improves claims workflows by identifying bottlenecks, documenting current and future processes, defining requirements, and supporting system enhancements. The role partners with stakeholders and vendors on Duck Creek Claims and OnBase, conducts testing, maintains process documentation and metrics, supports audits, and presents improvement recommendations. It also leads or participates in business process reengineering, data consistency initiatives, and continuous improvement efforts.

Assists with designing, testing, implementing, and improving billing processes. Performs user acceptance testing, investigates billing discrepancies, runs SQL queries, monitors invoice generation, prepares analytical reports, and ensures compliance with policies and insurance regulations. The role also handles ad hoc billing requests, customer inquiries, documentation, cross-training, and collaboration across departments to maintain accurate and efficient billing operations.