Claims Examiner jobs in Des Moines, IA

Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)

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Commercial Claims Examiner II
  • Merchants Bonding Company
  • Des Moines, IA FULL_TIME
  • Job Title: Commercial Claims Examiner II Department: Claims


    Position reports to
    : Senior Claims Attorney – Commercial Claims Manager


    Positions that report to this position
    : None


    DOL Classification
    : Exempt


    Job Purpose:

    The Commercial Claims Examiner II is responsible to investigate and adjust complex commercial claims made on surety and fidelity bonds and E&O policies, seek salvage and indemnity and prepare closing file documentation. The Commercial Claims Examiner II works independently and with oversight from department leaders. This role works closely with outside counsel, engages directly with and is responsive to the needs of key agency partners, coordinates payment of loss and expense checks, sets and revises reserves and pursues salvage and indemnity claims, as appropriate. The Commercial Claims Examiner II also mentors new commercial claims examiner hires, assists other departments within the organization, and works with management to prepare and give presentations on relevant commercial claims topics.

    Job Responsibilities:

    Claim Investigation and Loss Analysis

    • Reviews and analyzes correspondence and documents primarily submitted by claimants and principals, interviews involved persons and requests additional documentation in order to determine loss and exposure.
    • Documents investigation efforts in claim file and maintains relevant file documentation within SIMS claim file.
    • If necessary, retains consultants or outside counsel to assist with claim investigation, defense, or salvage and indemnity aspects of claim.
    • Evaluates potential sources of salvage, reimbursement and indemnification for any loss or expense that may be paid. Pursues recovery of loss, expenses and costs in accordance with the terms of the indemnity agreement or the surety’s statutory or common law equitable rights or rights of equitable subrogation as appropriate.
    • Negotiates directly with stakeholders to resolve claims, including creating secured re-payment plans, referrals to collection agencies or pursuing indemnity actions.
    • Drafts reasoned determination letters and reviews recommendations with Senior Claims Attorney – Commercial Claims Manager, as appropriate. Prepares documentation for payments.
    • Makes decisions regarding collateral or other indemnity or subrogation rights with assistance of Senior Claims Attorney – Commercial Claims Manager as appropriate. Coordinates with accounting on large losses or to establish cash collateral accounts. Obtains reimbursement pursuant to agreements such as collateral trust agreements.
    • Audits journal entries periodically for accuracy.
    • Makes reserve recommendations and posts reserves.
    • Conducts review of entire principal account, including open bonds, principal file and involves underwriters and agents as appropriate.
    • Prepares correspondence and documents for claimants, principals or third parties along with underwriters and agents, if necessary.
    • Attend meetings and legal proceedings independently or in collaboration with Senior Claims Attorney – Commercial Claims Manager as appropriate in connection with claims handling process.
    • Prepares and delivers presentations within the organization and participates in learning opportunities with underwriters and other internal staff.

    Research and Consultation

    • Seeks legal counsel or retains consultants as appropriate based on the merits of the claims. Audits outcomes and performance to assure competence. Reviews bills for accuracy and reasonableness. Authorizes payment.
    • Stays abreast of commercial claims handling requirements in corresponding jurisdictions and attends required claim and anti-fraud training.
    • Reviews and analyzes bond language, contracts, codes, statutes and case law, as applicable to specific claims.
    • Stays abreast of statutory changes or other developments potentially impacting bond liability.
    • Coordinates with the compliance department to obtain new licenses, if appropriate.
    • Assists claims department with projects as required from time to time.
    • Provides support to key agency partners.
    • Participates in mentorship and training of commercial claims examiners.

    Reporting

    • Prepares year end reports, as required, for files by reviewing: status of open claims, principal’s financial condition and evaluating accounts for necessary reserve changes.
    • Prepares closing memorandums summarizing the claim issues and resolution as well as losses incurred and salvage recovered.
    • Prepare claim summaries or other reports for compliance department as necessary.
    • Attends industry conferences and events as appropriate.
    • Assists management with monthly reporting to key agency partners as requested.
    • Prepare reserve summaries with assistance of management for internal and external reporting purposes.

    Qualifications:

    Education and Experience

    Bachelor’s degree in Finance, Accounting, Business or Economics or equivalent work experience plus 10 years of experience investigating and adjudicating commercial claims in the surety industry.

    Per the claims adjuster licensing policy, must be able to acquire within the first 30 days of employment and maintain an adjuster’s license in every state that requires a license.

    Skills and Knowledge

    Organization, ability to work independently, attention to detail, above average written and oral communications, problem-solving, tact, diplomacy, understands how to handle sensitive and confidential information and materials, ability to meet strict deadlines, research, accuracy, ability to communicate effectively with a variety of personalities. Able to communicate effectively via e-mail, fax, written correspondence and/or telephone, as necessary.

    Proficient with Microsoft Word and Excel. Familiarity with other Microsoft Office Suite applications. Proficient with PC hardware and peripherals. Ability to operate a variety of office equipment including copiers and telephones.

    Essential Functions:

    This person needs to have critical thinking skills to investigate and adjudicate claim situations. They need to be able to physically examine construction sites and claims locations. They require a high degree of detail orientation and accuracy in their work and able to communicate complex concepts in an understandable way.

    Physical Demands:

    The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions.

    While performing the duties of this job, the associate is regularly required to talk or hear. The associate frequently is required to sit; walk; use hands to finger, handle or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch or crawl. The associate is infrequently required to stand. The associate may infrequently be asked to lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and ability to adjust focus.

    The associate may travel up to 15% of the time by air or car to other office or business locations.

    Working Conditions:

    The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    While performing the duties of this job, the associate is exposed to normal office working conditions that are climate controlled. The associate would not be exposed to extreme heat or cold or other workplace hazards. The noise level in the work environment is usually low. If required to physically visit sites to investigate and adjust claims, the incumbent could be exposed to outdoor conditions and the noise level present on construction sites.

    This job description is not intended to be an exhaustive list of skills, efforts, duties, responsibilities or working conditions associated with this position. The Commercial Claims Examiner II assumes other responsibilities as assigned by the VP – Claims.

  • 18 Days Ago

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IA - 1099 Property Claims Adjuster
  • Copper Claims Services, Inc.
  • Des Moines, IA FULL_TIME
  • 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA. Copper Claims Services excels in providing custom claims solutions fo...
  • 6 Days Ago

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Paramedical Examiner
  • APPS Paramedical Services
  • Mount Ayr, IA FULL_TIME
  • APPS Paramedical is the nation’s largest and most technologically advanced health information provider. Our network of health professionals conducts physical examinations, testing, and personal health...
  • 19 Days Ago

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Paramedical Examiner
  • APPS Paramedical Services
  • Pella, IA PART_TIME
  • APPS Paramedical is the nation’s largest and most technologically advanced health information provider. Our network of health professionals conducts physical examinations, testing, and personal health...
  • 19 Days Ago

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Paramedical Examiner
  • APPS Paramedical Services
  • Centerville, IA FULL_TIME
  • APPS Paramedical is the nation’s largest and most technologically advanced health information provider. Our network of health professionals conducts physical examinations, testing, and personal health...
  • 19 Days Ago

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Paramedical Examiner
  • APPS Paramedical Services
  • Guthrie, IA FULL_TIME
  • APPS Paramedical is the nation’s largest and most technologically advanced health information provider. Our network of health professionals conducts physical examinations, testing, and personal health...
  • 19 Days Ago

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0 Claims Examiner jobs found in Des Moines, IA area

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Life Insurance Agent/Broker (Remote)
  • Mitchell Agency
  • Des Moines, IA
  • We are looking for life insurance agents or unlicensed salespeople to work remotely for one of the fastest-growing compa...
  • 3/28/2024 12:00:00 AM

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Financial Professional Advisor
  • New York Life Des Moines GO
  • Des Moines, IA
  • Are you a leader who has the following traits? Competitive Ambitious Coachable Communicative Self-disciplined Authentic ...
  • 3/28/2024 12:00:00 AM

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Insurance sales
  • Primerica
  • Urbandale, IA
  • We want to add a motivated and personable new employee to our insurance agent team who is seeking a new learning opportu...
  • 3/27/2024 12:00:00 AM

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Customer Service Representative - Brighton
  • Metro Bank
  • West Des Moines, IA
  • **Customer Service Representative - Brighton** * **Team:** Retail & Business Banking * **Location:** Brighton * **County...
  • 3/27/2024 12:00:00 AM

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Financial Services Professional
  • Bankers Life
  • West Des Moines, IA
  • Bankers Life®, one of the most respected brands in the Financial Services industry, is seeking ambitious individuals to ...
  • 3/27/2024 12:00:00 AM

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Licensed Insurance Agent - Remote
  • Sullivan Agency
  • Carlisle, IA
  • The Sullivan Agency is seeking motivated, career-minded individuals to join our team, helping families protect their hom...
  • 3/26/2024 12:00:00 AM

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Licensed Independent Medicare Insurance Agent - Remote
  • Assurance
  • Des Moines, IA
  • Medicare agents - sell Medicare Advantage, Medicare Supplement and PDP from home this AEP! Assurance is looking for lice...
  • 3/25/2024 12:00:00 AM

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Remote Life Insurance Agent
  • The Alicea Insurance Agency
  • Urbandale, IA
  • Organization Description: The Alicea Insurance Agency is an insurance and financial services agency. Our company was fou...
  • 3/25/2024 12:00:00 AM

Des Moines (/dɪˈmɔɪn/ (listen)) is the capital and the most populous city in the U.S. state of Iowa. It is also the county seat of Polk County. A small part of the city extends into Warren County. It was incorporated on September 22, 1851, as Fort Des Moines, which was shortened to "Des Moines" in 1857. It is on and named after the Des Moines River, which likely was adapted from the early French name, Rivière des Moines, meaning "River of the Monks". The city's population was 217,521 as of the 2017 population estimate. The five-county metropolitan area is ranked 89th in terms of population in ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$46,098 to $61,130
Des Moines, Iowa area prices
were up 0.8% from a year ago