Claims Examiner - Complex

Claims Examiner – Complex

Orion
180 Insurance Services LLC is seeking an experienced Claims Examiner to work in our Melbourne, Florida or Dallas, Texas offices. The role focuses on investigating, evaluating, and resolving complex litigated claims, mediations, appraisals, and claims involving third parties.

• Review Claims: Assess and analyze submitted claims documentation to determine validity and coverage.
• Gather Essential Information: Communicate with policyholders, witnesses, and other involved parties to collect relevant details for claims evaluation.
• Document Findings Thoroughly: Create detailed reports and maintain comprehensive notes to support claims assessments.
• Analyze Coverage: Review insurance policies to determine applicable coverage and assess liability.
• Prepare Reports: Submit thorough reports with findings and well-supported recommendations for claim settlements.
• Negotiate Settlements: Work with policyholders and third parties to negotiate settlements that ensure fair and just outcomes.
• Resolve Disputes: Handle disputes professionally and efficiently, ensuring favorable resolutions.
• Maintain Clear Communication: Foster transparent and professional communication with policyholders and all stakeholders throughout the claims process.
• Collaborate Across Teams: Partner with internal teams, including underwriters and legal advisors, to resolve complex claims.
• Ensure Compliance: Comply with state and federal regulations and company policies in all claims processes.
• Support Catastrophe Response: Provide critical support for claims management efforts during disaster events as needed.

• Experience: Minimum of 7+ years in a claim adjusting role, with direct experience handling litigated claims, mediations, appraisals, and claims involving third parties. Experience handling Florida property claims is strongly preferred.
• Technical
  
  Skills:
  
  Proficiency with CMS, Microsoft Suite, strong analytical, investigative, and problem‑solving skills; solid understanding of legal concepts surrounding liability claims.
• Licensing and
  
  Certifications:
  
  Valid adjuster’s license in home state and Florida required.
• Insurance Knowledge: Strong understanding of insurance policies, coverage evaluation, claim investigation, and dispute resolution throughout the life of a file. Demonstrated advanced understanding of all issues related to liability claims, including state regulations, case law, and statutes.
• Negotiation
  
  Skills:
  
  Excellent negotiation and communication skills, with proven ability to manage complex conversations and drive fair claim resolution with insureds, vendors, attorneys, and public adjusters.

• Dynamic Environment: Thrive in a fast‑paced, collaborative, and results‑driven office where your contributions make a real impact.
• Career Growth: Opportunities for professional development and advancement within a supportive company culture.

The office environment is fast‑paced and collaborative. An employee must be willing and able to work the regularly assigned work schedule onsite, and in times of need, be able to work an extended schedule depending on company or departmental needs, project requirements, or customer demands.

While performing general duties for this position, the employee is regularly required to sit, stand, and/or walk around (including the use of stairs). Other demands include the ability to openly communicate with others by talking, listening, comprehending, and reading; the ability to lift light objects (≤25 lbs); and the use of standard office equipment such as computers, printers, and phones. Occasional need to bend, twist, or squat down to open/close cabinets and reach for files or other standard office‑type objects.

Orion
180 is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Reasonable accommodations are available for qualified individuals with disabilities during the application process. Applicants who need accommodations may email  to request assistance.