Claims Adjuster

Claims Adjuster I

The Claims Adjuster I reviews claims related to property damage or loss. This position reports to the Claims Team Lead and works with various experts during the claims process to obtain accurate assessments and support in claims decisions. The Claims Adjuster I partners with Claims Trainer and Claims Team Lead to interpret the terms and conditions of insurance policies to determine coverage and exclusions applicable to each claim.

This position also engages with policyholders to gather information, provide updates on the status of claims, and explain the claims process and decisions.

• Maintains accurate and detailed notes regarding interactions, decisions, and actions taken throughout a claim.
• Partners with Claims Team Lead and Trainers to review, evaluate, and investigate photos, estimates, forms, receipts, inspection reports, and official reports presented on a claim.
• Reviews, partners, and processes property damage claims submitted by policyholders.
• Reviews insurance policies to determine coverage by working with Claims Trainers and leadership to interpret and apply policy provisions to claims under consideration based on coverage and investigation findings.
• Conducts, records, and interviews with those insured to secure information regarding personal loss.
• Works with claimants or representatives of claimants (contractors, public adjusters, attorneys, or other legal representatives) to gather necessary information regarding the claim and to negotiate fair and equitable settlements, overseen by Claims Team Lead.
• Collaborates with other insurance carriers as needed regarding duplicate claims and coverage.
• Selects and assigns claims for inspections.
• Requests and issues settlement checks with explanation letters based on policy terms and investigation findings, with limited authority.
• Prepares and issues denial letters to claimants, clearly outlining the reasons for denial based on policy terms and investigation findings.
• Identifies potential fraudulent claims and refers for additional investigation as warranted.
• Ensures claims handling complies with company and regulatory policies.
• Escalates complex insurance claims to management and legal teams including those subject to complaints and litigation.
• Consults with Claims Team Leads to resolve disagreements with a claim, utilizing alternative dispute resolutions (arbitration, appraisal, and mediation).
• Collaborates with management on arbitration, appraisal, and mediations.
• Maintains workflow to ensure timely processing of claims.
• Partners with Claims leadership on difficult or unusual situations that arise on claims.
• Prepares response letters to complaints or legal issues received.

• Provides excellent customer service by maintaining professional and constant dialogue with claimants in addition to handling claims promptly, efficiently, and with empathy.
• Communicates regularly with policyholders or other relevant parties providing updates on the status of claims and addressing any questions or concerns.
• Provides support to related teams during high work volume to meet or exceed established service levels.
• Educates policyholders on the claim process and coverages by maintaining open communication throughout the claim duration.
• Sorts and responds to incoming emails.

• Assists with one-on-one training or job shadowing for new hires.
• Completes required state continuing education requirements to maintain and renew adjuster license.

• Capability of gathering facts accurately, analyzing causes, evaluating alternate solutions, and arriving at sound conclusions on action to be taken.
• Ability to manage multiple and/or conflicting responsibilities.
• Great attention to detail, organizational skills, and time management.
• Good sense of urgency and follow up.
• Ability to handle stressful situations.
• Ability to work in a team environment.
• Ability to make relatively complex decisions.

• A current Property & Casualty Adjuster license preferred but not required. Must obtain license within 90 days of hire if not currently licensed and maintain state licensing requirements…