Claim Examiner

About Loggerhead Risk Management LLC

Loggerhead is a property and casualty insurer that specializes in providing coverage that meets the unique needs of Florida homeowners.

We’re a team of insurance professionals with customer service as our core value and we know the importance of attentively serving our policyholders. Loggerhead is powered by modern technology, guided by people who share a commitment to trust, empathy, and always doing what’s right, teamwork, and flexibility.

Job description

What is the Role?

As part of Loggerhead’s Claims team, the Claim Examiner is responsible for receiving, investigating, and adjusting complex first and third-party homeowner claims, with a focus on Alternate Dispute Resolution (ADR) and Litigation. The examiner will work under minimal supervision with authority commensurate with experience.

A Day in the life could include:

Make 1st contact, set expectations with regard to coverage, limits/sublimit, deducible and

offer emergency services to Policyholders in need.

• Triage new claims and direct the appropriate adjustment method
• Initial and subsequent indemnity and expense reserving
• Report claims to ISO and evaluate loss history
• Take recorded statements of Policyholders, injured parties and other involved parties
• Prepare and send acknowledgement, status, reservation of rights, or denial letters
• Investigate coverage and/or liability and document within the claim management system
• Notate all investigative activity within the claim management system
• Follow up with other parties to secure necessary information to evaluate claims
• Investigate and evaluate injury claims and report Medicare eligible claimants for Section 111 compliance
• Collaborate with the SIU department investigating potentially fraudulent claims
• Pursue all potential subrogation/contribution recovery avenues
• Analyze all claim documentation to calculate contractual monies owed, or recommend denial of those not owed
• Issue indemnity and expense payments/recoveries in the Claim Management System
• Report known Underwriting issues for risk evaluation
• Attend mediations to resolve disputed claims
• Oversee claims throughout the appraisal process and apply coverage to panel awards prior to payment
• Timely and effectively reply to Notices of Intent to Litigate (NOIL)
• Timely and effectively work with counsel to respond to Civil Remedy Notices (CRN)
• Oversee litigated matters and direct counsel throughout the litigation lifecycle
• Seek Management guidance for issues of coverage, claims in excess of monitory authority and when investigative steps are not clear
• Identify, investigate and help resolve production errors in our Claim Management System
• Assist other team members as needed

How we position you for success:

• 
  We empower you to be the expert by providing you with extensive training, consistent support, and by rewarding you for your success through our attainable bonus structure.
• No Prospecting – As a part of the inside sales team, leads are delivered directly to you.
• Best-In-Class Leaders and Teams – Work alongside a team of equally ambitious and passionate colleagues, while always feeling supported and valued from the top-down.
• Reputable Product – Loggerhead offers a competitive homeowner's product.
• Respect & Appreciation – Join a team where diverse perspectives are respected and always welcome.

What You'll Need to be a Top Candidate:

Skills

• 
  Excellent team-oriented interpersonal skills, with the ability to effectively collaborate with a broad range of internal/external contacts and roles, including vendors, Public Adjusters, Contractors and Attorneys
• Ability to contribute and collaborate as a team member while working proactively and independently
• Excellent presentation, persuasion, written, telephonic and interpersonal skills
• Excellent attention to detail, organizational skills, time management, and analytical skills
• Enthusiasm for growth, learning and developing new opportunities with the company as it launches new products and services for its Policyholders

Knowledge & Experience

• 
  8 years industry experience adjusting 1st and 3rd party homeowner claims in Florida
• Demonstrable experience performing each key responsibility satisfactorily
• Significant knowledge of building construction, damage evaluation and repair methods
• Significant knowledge of negotiation tactics and dispute resolution
• Significant knowledge of Florida’s legal system process
• Significant experience using internet software, MS Office and Xactware products
• Knowledge of injury mechanics, human anatomy, and medical treatment

Education & Certifications

• 
  Bachelor’s degree in business, Risk Management, or equivalent experience
• Insurance related designations, such as Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU)
• Florida all lines adjuster license

Working Conditions:

• 
  Remote work-from-home work environment with occasional time spent at the Tampa Corporate Headquarters for training and corporate/departmental meetings
• May be required to work flexible hours and/or weekends dependent on claim volume and Catastrophes
• May be required to travel to other domestic locations (primarily in Florida), as needed

Travel: Minimum, as required.

ADA: The above statements cover what are generally believed to be the principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of job duties.

Job Type: Full-time

Compensation & Benefits:

• 
  Market Competitive Salary
• Comprehensive benefits package including company paid time off, comprehensive insurance plans, and 401k plan with company contribution

Additional Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
• Referral Program
• Tuition Reimbursement

Schedule:

• Monday to Friday

Work Location: Remote