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CRC Group: Claims Examiner Trainee

CRC Group

This is a Full-time position in Fort Worth, TX posted September 3, 2021.

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Regular or Temporary:Regular Language Fluency: English (Required) Work Shift:1st shift (United States of America) Please review the following job description: The incumbent is required to successfully complete the Company developed training program that will provide the education necessary in order to succeed as a Claims Examiner.

The incumbent is responsible for continually demonstrating the progressive ability to perform the required essential job functions, as well as grow in the ability to process, evaluate, negotiate, adjust and resolve non-complex, standard claims in accordance with prescribed authority and best claims practices.

Essential Job FunctionsDevelop relationships with customers via telephone, investigate insurance policy coverage, determine cause of loss, and document activity on each claim to come to a resolution quickly and accurately.Identify, analyze, and resolve coverage issues according to established Company protocol, including thorough policy review and analysis of application to the individual claim.

Develop and direct investigative plans.

Conduct timely and detailed investigations that include scene investigation (e.G., photos, diagrams, blueprints, maps), statements, official reports (e.G., police, fire, weather, hail), and ownership documents (e.G., tax liens, judgments, encumbrances).

Identify alleged and actual damages, identify potential liable parties, recognize and address potential fraud.

Conduct thorough damage development, leading to timely and adequate evaluations, including appraisals/estimates, business records, invoices, detailed inventory, purchase records, receipts, credit card statements, and ALE documents.

Develop appropriate methods of repair/replacement, verify ownership, and apply any special limitations.

Establish voice to voice communication within 24-hours.

Maintain effective communications with the customer at all times.

Consistently work within specific time limits and authority.

Maintain company reputation and integrity of insurance products by complying with federal and state regulations, Company protocol, and service standards.

Maintain current knowledge of regulations and issues, industry activity, and trends.

Under supervisor authority, negotiate with policyholders to settle claims of limited monetary value.

Perform technical reviews of appraiser and contractor property damage estimates.

Assure accurate and timely case reserving by evaluating reserves as additional information is developed and revising accordingly.

Confirm the reserves represent the most likely ultimate cost of the loss, based on known and reasonably foreseeable facts.

Effectively and efficiently manage independent adjusters, experts, and vendors.

Ensure assignments outline specific tasks, fees and time frames are agreed upon at time of assignment, and invoices are reviewed to confirm charges are limited to the assigned tasks and are specific to given instructions.

Ensure thorough and timely claims reporting.

Prepare and distribute SLAs, SLRs, and Underwriting Alerts per accepted protocol.

Ensure appropriate handling of time-sensitive documents, addressing time sensitive documents with the Claims Supervisor within the prescribed time frame.

Interface with others within the Company to analyze and improve program performance.

Keep management informed of issues that represent a significant risk to the company or that jeopardize the achievement of overall corporate objectives.

Partner with SIU and Subrogation to identify questionable claims and subrogation opportunities.

Assist or prepare files for suit, trial, or subrogation.

Support work-load surges due to weather-related events as needed.

Complete any special projects assigned and perform other duties as may be assigned.Knowledge, Skills and Abilities (Essential)Ability to maintain a high level of confidentiality.Ability to communicate professionally and respectfully interpersonally and otherwise, with internal and external customers.Ability to perform tasks with frequent interruptions and/or distractions.Ability to work effectively in the faces of stress, ambiguity, difficult situations, and shifting priorities.Ability to work additional hours, beyond the core business hours, upon request.Ability to maintain regular, reliable and predictable attendance.

Ability to adhere to set work hours determined by management.Knowledge of, or the ability to learn, apply, and comply with, Company policies and procedures.Ability to successfully complete Company training program, achieving a passing score on all claims training exams.

Ability to possess and maintain Adjusters License for states in which the Company conducts business.

Knowledge of principles and processes for providing excellent customer service, including addressing customer needs, meeting quality standards for service as set by department and maintaining customer satisfaction.

Ability to work effectively and patiently with customers.

Ability to diffuse and respond effectively to situations involving intense pressures or stressful situations, as well as unpredictable and/or angry persons while maintaining professional composure.

Ability to work effectively and patiently with customers.

Knowledge of general claims handling processes and procedures, as well as insurance industry regulations and guidelines.

Knowledge of Fair Claims Practices.

Knowledge of legal doctrines and principles.

Ability to read, analyze, and interpret information with some being technical in nature on a limited basis, such as insurance policies, regulations, and reports.

Knowledge of and ability to understand and remain current in local, state, and federal laws, claims investigation processes, and types of insurance policies.

Knowledge of standard office equipment and machines, including printers, copiers, and calculators.

Ability to use software packages including document management, estimating programs (such as Xactimate).

Strongly proficient in Microsoft Office, specifically Microsoft Word and Microsoft Excel.

Ability to make arithmetical computations and tabulations.

Ability to effectively maintain expected case load as set by the department, as well as organize and prioritize own work schedule on short-term basis while maintaining a satisfactory work product.

Ability to perform repetitive work according to set procedures and carry out independent action on routine responsibilities, as well as handle non-routine projects and tasks with moderate supervision.

Work successfully as a member of a team.

Requires effective management of mental stress due to the nature and scope of the position.

S trong organization skills, with the ability to multi-task, pay close attention to detail and possess advanced problem solving skills.

Ability to compose materials such as letters, outlines, memoranda, and basic reports and orally communicate thoughts and ideas to both technical and non-technical audiences.

Outstanding oral and written communication skills, including the ability to effectively interact with supervisors, peers, claimants, contractors, and outside suppliers/vendors.

Ability to effectively communicate at all levels of Company management and employees.

Ability to understand opposing points of view on complex issues and to negotiate and integrate different viewpoints.

Ability to effectively manage projects of a lengthy, on-going and complex nature simultaneously while maintaining a satisfactory work product, as well as meet aggressive deadlines with well-tested solutions.

Ability to exercise sound judgment in selecting methods or techniques for obtaining solutions.

Ability to apply general rules to specific problems to produce answers that make sense.

Ability to understand complex problems and to collaborate and explore alternative solutions with management.

Ability to understand complex problems, collaborate with others and explore alternative solutions.Ability to listen and understand information, instruction, and ideas presented through spoken words and/or written instruction and apply accordingly.Ability to translate from English to Spanish and vice versa preferred.

Working Conditions/Requirements (Essential)Requires work in a normal office environment with changing deadlines, project assignments, and strict time constraints.

May require visits outside the office and occasional overnight travel.Requires visits to varying worksites with unknown conditions which may include maneuvering in tight or small places.Requires lifting, carrying and other wise transporting work-related materials that frequently weigh up to 10 pounds and that may occasionally weigh in excess of 10 pounds.Requires repetitive movement of wrists, hands, and/or fingers for sustained periods of time.Requires standing less than 1/3 of the time.Requires walking (traversing) less than 1/3 of the time.Requires sitting more than 2/3 of the time.Requires use of fingers and hands or feeling more than 2/3 of the time.Requires talking or hearing more than 2/3 of the time.Requires close vision, defined as clear vision at 20 inches or less.

Minimum Required Education and ExperienceGenerally 0-6 months related, applicable experience.

Associates degree (A.A.

or A.S.) or equivalent from a two-year college, business school, or technical school.

Adjusters License for states in which the Company conducts business.

Fluency in Spanish preferred.

CRC is an Equal Opportunity Employer and considers all qualified applicants regardless of race, gender, color, religion, national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law.

EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify