Claim Operator Jobs (NOW HIRING)

Position Summary:

The Desk Adjuster manages the full lifecycle of assigned claims, serving as both the subject matter expert and primary point of contact for the insured. This includes claim review and prior history, evaluating inspection documents, determining coverage, assessing and communicating damage, setting reserves, issuing payments, and reaching settlements. The individual in this role maintains full ownership of each claim, ensures ongoing follow-up, and adheres to all compliance requirements until the claim is fully resolved.

Key Responsibilities:

• Investigate claims by verifying facts through policy review, endorsements, and interviews with insured parties and other relevant individuals, and write estimates or denial based on coverage determination.
• Review documentation for completeness, accuracy, and compliance with carrier policies
• Ensure all collected information is accurate and identify potentially fraudulent activity, following up on discrepancies
• Set appropriate reserves and recommend reasonable and accurate claim payments in a timely manner
• Adhere to carrier Service Level Objectives (SLOs) and claim closure requirements
• Draft and deliver clear, professionally written correspondence, including claim-related letters and communications
• Exercise sound judgment and critical thinking to resolve complex claim issues
• Communicate effectively and promptly with insureds, claimants, and internal stakeholders in a courteous and professional manner
• Maintain detailed, organized file documentation to support the claim; when needed, make revisions and/or collaborate on files
• Serve as technical subject matter expert and support team members by sharing knowledge and assisting with workload when needed
• Prepare and submit all required claim documentation in a timely manner.
• Provide regular updates on claim status to management and leadership and escalate to management when necessary following established procedures.
• Attend and participate in training sessions, team meetings, and projects as needed.
• Deliver excellent customer service and maintain a high level of professionalism in all interactions.
• Adhere to all applicable State Insurance Regulation requirements and other applicable laws, regulations, and standards
• Assume personal responsibility for maintaining the requisite state license for the state(s) assigned.
• Perform additional duties as assigned

Qualifications:

• High School Diploma or equivalent
• Minimum of two years' experience in claim handling, estimating, and policy interpretation required
• Experience handling claims in the California market is a plus
• Proficient with complex claims handling procedures preferred
• Must have experience handling weather water and non-weather water perils
• Must be familiar with water mitigation practices
• Proficient in Xactimate, Snapsheet and Guidewire CMS experience is a plus.
• Proficient in writing estimates over the phone and from various sources
• Proficient computer skills with Microsoft Word, Excel, PowerPoint, and Adobe Acrobat
• Experience with taking recorded statements is a plus
• Strong focus on customer service.
• Self-motivated, and critical thinker who can work independently and use sound judgment to solve problems
• Strong written and verbal communication skills
• High level of time management skills
• Ability to multitask and quickly adapt to changing/conflicting priorities
• Excellent attention to detail
• Strong relationship building skills and ability to work well with others
• Possess the requisite state license for the state(s) assigned.

Physical Activities and Requirements

Work involves prolonged periods sitting at a desk; continuously working on a computer using manual dexterity; operating office equipment, cell phone usage, walking, face to face discussions and web-based meeting participation. Continuously requires vision, hearing and communication.

Schedule Availability

Willingness to work a varied schedule, as needed; may require weekend work days and accommodation of occasional meetings and work activities scheduled outside normal business hours

Salary: $50,000 + commission