Senior Claims Examiner

The following are the usual, basic and essential functions of the Sr. Claims Examiner position. However, this job description does not preclude the performance of other duties by the incumbent. These functions are not to be construed as an exhaustive list of all responsibilities, duties, and skills required:

Demonstrates a customer centric attitude

Analyzes and manages claims by verifying coverage and investigating and gathering pertinent information to determine the exposure on the claim

Maintains well-developed action plans for an appropriate and timely resolution in accordance with established policies and procedures

Recognizes and properly addresses coverage issues, potential fraud, and subrogation potential

Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim

Conducts detailed damage and bill reviews and controls claim expenses

Pays and processes claims within designated authority level or denies payments where no coverage, liability, or compensability exists

Enters claim payments and reserves on claims on computer system, inputting concise and accurate file documentation

Communicates decisions in a clear and professional manner

May provide training, coordination, and investigation of potential fraudulent activity for the Association.

Bachelor’s degree or 6+ years of relevant work experience

Texas Adjuster License

This position requires the Sr. Claims Examiner to obtain the Associate in Claims designation within two years of the date of hire/promotion, or the Chartered Property Casualty Underwriter designation within three years of the date of hire.