Claims Compliance Specialist

Description

Position Summary:

The Claims Compliance Specialist is responsible for managing pending claim tasks and activities pertinent to maintaining compliance with legal statute and internal processes. This role involves coordinating with adjusters, vendors and management on claim tasks that are necessary to maintain proper compliance.

Essential Functions:

The Claims Compliance Specialist monitors claims and outstanding tasks and coordinates or performs handling functions to ensure claims remain in compliance.

• Monitors open tasks and claims based on defined processes and activities to identify claims that need handling by an adjuster.
• Coordinates with the assigned adjuster, supervisor, and/or vendor to ensure actions needed are completed accurately and in a timely manner.
• Performs handling activities on claims based on internal compliance procedures (e.g., contacting insureds, conducting claim investigations, evaluating loss estimates, making coverage decisions, issuing payments, etc.)
• Tracks and reports on tasks, claims and handling activity to support management reporting.
• Assists in training on compliance and claim handling processes.
• Participates in projects and meetings with management as requested.

Qualifications

Required Education and Experience:

• High School diploma required; College degree preferred
• Florida licensed All-Lines adjuster (620)
• 5+ years of property claims adjustment experience or similar experience required
• Knowledge of property insurance policy and coverage analysis
• Demonstrated expertise with Florida Homeowners claims

Essential Skills:

• Attention to detail
• Organizational skills to manage multiple items simultaneously
• Adaptable to change
• Strong communication, verbal and written
• Experienced working with MS including Outlook, Excel, Word, and Teams