PROPERTY(Residential/ Commercial Insurance) Senior TPA Claims Examiner

Atlanta, GA 

 

Full-Time

We are seeking an experienced Senior Property TPA Claims Examiner to become a part of our organization.

Duties and Responsibilities:

  • Review/analyze issued insurance policies for submitted claims to identify and interpret coverage and make timely coverage decisions
  • Promptly communicate with insureds, claimants, retail agents, general agents, independent adjusters and attorneys as appropriate
  • Document plan of action in the claim system and set appropriate diaries to continually drive claims toward prompt resolution and closure
  • Determine the need on a per-claim basis for outside services (adjusters, experts, etc.), and provide written assignment instructions to the appropriate parties accordingly
  • Monitor developments and hold assigned service providers accountable for timeliness, adherence to assigned tasks, and quality service
  • Establish and maintain accurate loss and loss expense reserves
  • Review reports from independent adjusters/other service providers for accuracy and completeness
  • Strategize and take prompt action to obtain proper claim results in accordance with best claim practices
  • Process claim settlements for smaller and less complex claims. Provide recommendations on larger claim settlements or denials and obtain required authorities when necessary
  • Prepare claim correspondence that includes Assignment Instructions, Non-Waiver Agreements, Reservation of Rights, Denial letters, Sworn Statements in Proof of Loss, Statements of Loss and explanatory letters when appropriate, obtaining required authorization when needed
  • Maintain timely, accurate, well-organized and complete records of claim activity and correspondence both sent and received in the claim system
  • Identify subrogation target opportunities and lead recovery efforts

Qualifications

  • Minimum of 3 years of first-party property adjusting experience
  • Must possess, or have the ability to immediately obtain, a GA Adjuster License and other state Adjuster License(s) as required
  • Adequate working knowledge of insurance industry standards and insurance claims, particularly residential and commercial property claims, property policy construction, ISO Commercial Property forms, and property insurance coverage evaluation/interpretation
  • Commitment to continued learning and ongoing insurance education
  • Exceptional communication (both written and verbal), influencing, evaluation, negotiating, listening, and interpersonal skills
  • Proficiency with MS Word, MS Excel, MS Outlook
  • Ability to learn new IT applications, such as TPA claim systems
  • Ability to critically evaluate policy coverages against claim circumstances/loss information developed and promptly act
  • Familiarity with Xactimate estimates and valuations, and the ability to modify if needed
  • Outstanding organizational skills and ability to effectively maintain a diary system
  • Customer-focused attitude to quickly and effectively respond to inquiries
  • Ability to properly handle a full case load in a fast-paced environment with minimal supervision
  • Ability and willingness to commit to extended schedules following significant catastrophe losses or during other periods of unusually high claims volume
  • Bachelor’s degree preferred
  • TPA experience a plus
  • Insurance designations (AIC and CPCU) are a plus
  • Litigation experience (except worker’s compensation) is also a plus


Salary and bonus program (if applicable) commensurate with experience.