POSITION SUMMARY
Process insurance claims for property losses based on coverage, appraisal, and verifiable damage. Interact with independent adjusters and policy holders, review claim forms and other records to determine insurance coverage. Make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.
PRINCIPAL DUTIES AND RESPONSIBILITIES
• Investigate, evaluate, and resolve claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.
• Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies.
• Enter claim transactions, in a clear and concise manner.
• Examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders.
• Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations.
• Pay and process claims within designated authority level.
• Supervise independent adjusters to ensure adherence to CFP IA Guidelines.
• Maintain compliance with the Department of Insurance and Company policy and procedures.
• Create correspondence to policyholders that is accurate and complete. Communicate with insureds and/or others involved to secure missing information.
• Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims.
• Confer with Claims Management and legal counsel on claims involving litigation.
ADDITIONAL DUTIES AND RESPONSIBILITIES
This role may include handling the entire claim (except inspection), or may be responsible for a specific coverage, such as Personal Property or Fair Rental Value. This role will focus on claims ranging from $100,000 to $300,000 in damages, but the Claims Examiner II may receive larger or smaller claims when necessary.
EDUCATION AND EXPERIENCE
• Minimum bachelor’s degree or equivalent preferred.
• Excellent oral and written communication skills.
• Working experience with MS-Office (especially Word and Excel) is required.
• 2 + years property claims experience and excellent customer service.
• Certified in CEA and Fair Claims Settlement Practices.
• 3 years total claims experience, 2 years handling HO claims up to $300,000
• 1 year Carrier Experience Required
Skills Required
- Bachelor's degree or equivalent
- Excellent oral and written communication skills
- Working experience with Microsoft Office, especially Word and Excel
- At least 2 years of property claims experience
- Excellent customer service experience
- Certification in CEA and Fair Claims Settlement Practices
- At least 3 years of total claims experience
- At least 2 years handling homeowners claims up to $300,000
- At least 1 year of carrier experience
What We Do
The California FAIR Plan is a private association comprised of all insurers authorized to write property insurance in California. The FAIR Plan was established in July 1968 following the 1960s brush fires and riots as the state’s insurer of last resort, created to ensure access to basic property insurance for California homeowners who have been unable to obtain homeowners insurance from the voluntary market for reasons outside of their control. The FAIR Plan will write fire insurance coverage for these homeowners, regardless of a property’s wildfire risk. The FAIR Plan is committed to strengthening consumer choices in the voluntary insurance market, while ensuring that all homeowners, including those who live in areas threatened by wildfires, can obtain basic property coverage and the peace of mind they deserve
