Complex Claims Examiner at Heritage Insurance Holdings, Inc.

Manages complex and/or large exposure files to bring them to resolution. Analyzes and reviews claims for accuracy, completeness and eligibility. Resolves claims by investigating losses, calculating and negotiating settlements. Prepares and maintains reports and records for processing. 

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigations, damages development, evaluations, reserving, litigation management, and disposition.

Essential Duties and Responsibilities:

• Handles 1st party property claims within all Heritage Companies states of moderate severity and complexity along with claims with large exposures as assigned, with little direction and oversight.
• Delivers outstanding customer service to all internal, external, current, and prospective Heritage Companies customers. Adheres to high standards of professional conduct while providing delivery of outstanding claim's service.

• Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.

• Performs detailed investigations and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate.

• Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and other experts. Requests through Unit Manager and coordinate the results of their efforts and findings.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.

• Maintains diary system, capturing all required data and documents claim file activities in accordance with established company guidelines.
• Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.

• Manages file inventory to ensure timely resolution of claims. Reports on pending claims and findings to the Claims Manager

• Communicate and interact with a variety of individuals to foster the timely resolution of claims, including, but not limited to, policyholders, public adjusters, attorneys, vendors, and experts.
• Reviews the insurance policy contract, policy endorsements and related documents to make a proper coverage determination.

• Opens, closes, and adjusts reserves according to company practices to ensure reserve adequacy. Adheres to file conferencing notification and authority procedures.
• Settles claim by determining insurance carrier’s liability and negotiating agreement with appropriate parties according to company policy provisions.
• Collects, updates and maintains all claim documentation including statements, pictures, reports, estimates, etc. and verifies the accuracy and completeness of claim forms.
• Negotiates disposition of claims with insured and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
• Attends depositions, EUOs, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Attends large loss meetings to discuss any claim concerns, and prepares any claim review forms as needed. 
• Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.

• Write denial letters, Reservation of Rights and other complex correspondence.

• Maintains current knowledge of local industry repair procedures and local market pricing.
• Maintains compliance with Claim Department's Best Practices.
• Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.

• May coach, counsel, and/or train less-experienced staff.
• Assist management when required with projects or leadership requests including travel as needed.
• May act as back up in leadership absence.

• Some overnight travel may be required.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.

Job Qualifications:

• Bachelor’s Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
• 6-20 Licensure required.
• Will be required to obtain Adjuster License in all Heritage Companies states.
• Three to five years of experience processing claims; property and casualty segment preferred.
• Experience with Xactware products preferred.
• Flexibility to work nontraditional hours.
• Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
• Proficiency with Microsoft Office products required; internet research tools preferred.
• Demonstrated customer service focus / superior customer service skills.
• Excellent communication skills and ability to interact on a professional level with internal and external personnel
• Results driven with strong problem solving and analytical skills.
• Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
• Detail-oriented and exceptionally organized
• Collaborative partner; ability to contribute to a positive work environment.

General Information:

All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.