Claims Examiner

Come work at a place where we take pride in creating a workplace environment that values hard work, commitment, and growth.

Job Description:

Education:

• High School diploma or equivalent required
• Associate’s degree in Business Administration or relevant field of study preferred
• Insurance adjuster license required

Work Experiences:

• 4+ years’ claims experience working with workers’ compensation, general liability, and property insurance preferably in an insurance related industry.
• We encourage candidates with prior examiner, adjuster, paralegal and/or other relevant claims handling experience to apply. Multi-jurisdictional knowledge, advanced degrees and/or JD are a plus.
• Texas non-subscription claims experience preferred
• Active Texas All Lines Adjuster license or able to obtain the specified license within ninety days of hire date

Skills:

• Ability to consistently apply sound judgment, and operate professionally, effectively and ethically as an individual contributor and member of a team
• Ability to establish rapport and maintain harmonious working relationships
• Superior interpersonal, written, and verbal communication skills, with the ability to create thorough documentation and interface effectively with individuals at various levels
• Excellent time management skills, ability to support multiple projects, and effectively prioritize and manage a large volume of work
• Ability to remain organized, pay strict attention to detail, and meet critical deadlines within a high volume, fast-paced environment
• Analytical with strong problem-solving abilities and creative resolution skills
• Maintain professional and technical knowledge by attending educational workshops and reviewing technical publications
• Proficient use of Microsoft Office programs, including Word and Excel

Responsibilities:

• Understands and performs domestic claim programs, policies, and procedures for:  reporting, investigation, and analysis; resolution/outcome management; and the delivery of claim information.
• Manage mostly non-complex claims, but may handle moderately complex claims with limited reserve and/or settlement authority including workers’ compensation, Texas non-subscription claims, general liability and property claims
• Maintain claims and insurance files
• Secure evidence related to claims (merchandise, statements, photos and video footage)
• Partner with external TPA and insurance carriers as needed
• Monitor claim files to ensure that external TPA is managing files appropriately and in accordance with Claims Service Handling Instructions, establishing appropriate reserves, and issuing benefit payments timely. Process service invoices occasionally
• Coordinate substance abuse testing for post-accident, reasonable suspicion, and property damage to include communication of results to appropriate business partners
• Partner with management on the status of injured team members and estimated return to work date
• Coordinate return-to-work efforts
• Facilitate superior service experience for the injured team members and customers
• Notify HR and Payroll of team members who have been placed on leave due to a work-related injury
• Generate various loss analysis reports as required
• Maintain current on changes in workers’ compensation laws and other claims-related laws, regulations, and information by attending educational workshops and seminars
• Develop a thorough understanding of Academy policies, procedures, and safety rules
• Duties may change; Team Members may be required to perform other duties as assigned
• Properly maintain applicable state license

Physical Requirements & Attendance:

• Acceptable level of hearing and vision to perform job duties
• Adhere to company work hours, policies, procedures and rules governing professional staff behavior

Full timeEqual Employment Opportunity

Academy is an Equal Opportunity Employer and does not discriminate with regard to employment opportunities or practices on the basis of race, religion, national origin, sex, age, disability, gender identity, sexual orientation, or any other category protected by law.​