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Claims Examiner

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Position Title:            Claims Examiner

Reports To:                Insurance Services Operations Manager

Department:              Insurance Services — Claims

FSLA Status:              Exempt

Union Status:             Non Union

Supervision:               No

Summary

The Claims Examiner is a property and casualty claims professional who provides excellent customer service to members of WEA Member Benefits (Member Benefits) and claimants.  The Claims Examiner is responsible for ensuring all members and claimants are treated with dignity and respect during property and casualty (P&C) claims adjudication process through clear, concise communication from the date of a loss through its final outcome and by fair, prompt, and accurate adjudicating of WEA P&C claims.  The incumbent must have thorough knowledge of the auto, home, and liability policies and must understand the claims process and related procedures to handle the most complex claims.

Accountabilities

70% — Claims Adjudication

  • Ensure WEA P&C’s Auto Liability, Physical Damage and Homeowner’s Liability and Property claims are accurately and efficiently adjudicated.
  • Take accurate and complete auto and home loss notices and document loss reports.
  • Explain the claims process to participants and claimants.
  • Investigate all circumstances of the loss, assess liability, and process first and third-party auto and homeowner property and liability claims by interviewing all appropriate parties; analyzing property estimates; reviewing police reports, physical damage assessments, body shop estimates, medical records and medical billings; interpreting policy coverage language and exclusions; and assessing liability and damage based on the available information.
  • Manage independent adjuster assignments.
  • Negotiate and approve the most complex auto and homeowner claims settlements in accordance with procedures and guidelines.
  • Exercise authority to issue expense and indemnity payments for more complex and costly claims within established limits as described in the WEA P&C Claims Procedures.
  • Supervise litigation files at the discretion of and under the supervision of the Insurance Services Operations Manager as needed.

25% — Quality and Timely Service

  • Respond to inquiries and complaints from individuals or their representatives on complex claims by meeting with them, through telephone contact, and/or by providing them with written, accurate investigation report documentation and other information as necessary.
  • Inform claimants of the status of their claims, keep them informed of the claims process, and communicate claims settlements.

5% — Special Projects

  • Perform special projects and duties as needed.

Required Experience and Knowledge 

  • High School Diploma or equivalent.
  • Three (3) to Five (5) years of progressively responsible experience adjudicating complex claims and interpreting auto liability, physical damage, and homeowners’ policies, including:
    • Create and examine loss reports; evaluate physical damage assignment reports and/or body shop estimates; conduct on-site inspections of claims damage cases.
    • Evaluate claims information and related legal requirements to accurately determine coverage, liability, and settlement value while also establishing and maintaining appropriate reserves, and requesting higher level review as appropriate.
    • Complete accurate, timely, and detailed file status reports.
  • Commitment to providing excellence in customer service and other Member Benefits values.
  • Experience using a personal computer, claims and policy administration systems, and company software.

Abilities

  • Excellent independent problem-identification and problem-solving skills; and the ability to perform in depth research and collect, logically organize, analyze information, and make effective decisions and/or recommendations.
  • Excellent verbal communication skills, including the ability to clearly, effectively, and persuasively communicate and negotiate with individuals and groups and to listen effectively.
  • Excellent written communication skills, including the ability to compose clear, concise, and persuasive correspondence and narrative reports that communicate messages using appropriate tone, grammar, and word usage.
  • Skill performing mathematical calculations.
  • Able to work independently and establish, monitor, and achieve goals with minimal supervision as well as the ability to work as a constructive member of a team.
  • Ability to maintain a respectful disposition in all dealings with participants, vendors, coworkers, and others that promotes teamwork.
  • Excellent organizational skills, including the ability to effectively and competently handle multiple priorities simultaneously and the flexibility and ability to quickly adapt to changes.

Preferred Experience, Knowledge and Abilities 

  • Membership or affiliation with property and casualty-related professional organizations.
  • Associate in Claims (AIC) designation.

Physical Demands and Work Environment

These physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.

  • Work is primarily performed in an office environment with minimal exposure to injury.
  • Must be able to lift and move up to 20 pounds.
  • Ongoing daily use of computers and telephone.
  • Walk, sit, stand, bend, climb, and use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk, hear, read, count, and write.
  • Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus.
  • Must be able to work with frequent interruption.
  • Low to moderate noise level.

To Apply

To apply for this position, please send your cover letter and resume as well as the completed employee application to apply@weabenefits.com.

Print, sign, and scan your application document and attach it to the email with your resume. OR mail your employee application separately to:

The Employer Group
c/o Mike Beringer
1000 Solar Ct.
Verona, WI 53593