Remote Field Adjuster – Complex Claims Specialist; CA

Field Adjuster

Field Adjuster - Complex Field Specialist

This is a remote role, must be based in Southern California, ideally San Diego area.

Analyzes and reviews claims for accuracy, completeness and eligibility. Resolves claims by investigating losses, calculating and negotiating settlements. Prepares and maintains reports and records for processing.

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.

• Follow and maintain claims management guidelines to determine insurance coverage by examining claims forms, policies, and other records as appropriate.
• Perform detailed investigations by coordinating field audits and performing in‑depth interviews both telephone and in person to research claims. Resolve claims by comparing claim information with evidence obtained to determine eligibility.
• Settles claim by determining insurance carrier’s liability and negotiating agreement with appropriate parties according to company policy provisions.
• Collects, updates and maintains all claim documentation including statements, pictures, reports, estimates, etc. and verifies the accuracy and completeness of claim forms.
• Reports on pending claims and findings to the Claims Manager.
• Provide updates on customer problems and safety or policy violations. Responds to inquiries and requests for information from customers and staff.
• Identifies exposures to the company and facilitates senior‑level management’s knowledge of pending claims and litigation that may have an adverse impact on the corporate goals.
• Acts as the liaison to attorneys, insurance companies and individuals investigating any incidents that may result in asset loss.
• Travels within an assigned region in the course of processing claims.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.
• Communicates with co‑workers, management, clients, vendors, and others as needed in a courteous and professional manner.
• May perform other duties and responsibilities as assigned.

• A High School Diploma or equivalent is required;
  Associate’s Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
• Three to five years of experience processing claims; in the property and casualty segment preferred.
• Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
• Proficiency with Microsoft Office products required; claims software and internet research tools preferred.
• Experience with Xactware products preferred.
• Demonstrate customer service focus / superior customer service skills.
• Ability to work in a fast paced environment; ability to multitask.
• Collaborative partner; ability to contribute to a positive work environment.
• Excellent communication skills and ability to interact on a professional level with internal and external personnel.
• Results driven with strong problem solving and analytical skills.
• Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
• Detail‑oriented and exceptionally organized.
• Ability to climb, kneel, and crawl required; may work in confined spaces. Ability to lift and move items up to 30 lbs. alone; more with assistance from a partner.

This position is based within an assigned region; travel throughout the region is required with occasional travel to locations beyond the assigned region. Company paid pre‑employment drug test and health screening required.

All employees must pass a pre‑employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work…